An Update On Medical Treatment for Intracerebral Hemorrhage
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EDITORIAL
An Update On Medical Treatment for Intracerebral Hemorrhage Xiang Li 1 & Dongxia Feng 2 & Gang Chen 1 Received: 30 August 2018 / Accepted: 4 September 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018
Intracerebral hemorrhage (ICH), as a kind of hemorrhage stroke, is characterized by high morbidity, mortality, and disability rates, which is a most serious disease in neurosurgery [1, 2]. There are about 2 million new cases of ICH around the world every year, and the incidence is as high as 20~30% in Asia, which is a serious threat to human health [3]. ICH is caused by the rupture of blood vessels, and blood flows into the surrounding brain parenchyma. As the global population ages, the incidence of ICH is predicted to increase. Therefore, understanding the pathogenesis of ICH and identification of novel targets are helpful to researchers for developing new drugs for ICH therapy. The aim of this editorial is to summarize the development of preclinical and clinical medical treatments for ICH. At the onset of ICH, within the first few hours, the bleeding leads to the formation of hematoma and mechanical damage to adjacent tissues, which results in a sharp increase in intracranial pressure and induces primary brain injury [4]. At present, surgical operation is adopted to remove hematoma and reduce the intracranial pressure [5]. The Surgical Trail in Intracerebral Hemorrhage (STICH) has failed to provide positive evidence to support the effect of surgical operation, and STICH2 also showed no benefit (NCT01320423) [6, 7]. However, surgical removal the hematoma after ICH shows only rarely effects in neurological recovery, and the outcomes for the patients are unsatisfied. Furthermore, some clinical trials on blood pressure medications showed no benefit, including intensive blood pressure reduction in acute cerebral hemorrhage trial 2 (INTERACT2, NCT00716079), ICHADAPT (NCT00963976), and ATACH-2 (NCT00226096)
* Gang Chen [email protected] 1
Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China
2
Department of Neurosurgery, Baylor Scott & White Medical Center, Texas A&M University College of Medicine, Temple 76508, USA
[8–10]. In addition, hematoma expansion also could be a target for ICH therapy. There are some clinical trials are tested targeting on haematoma expansion, like recombinant activated factor VIIα (SPOTLIGHT, NCT01359202; STOP-IT, NCT00810888) [11]. Recently, Vitamin K1 in the treatment of spontaneous ICH is tested in the phase I (NCT03388970, https://clinicaltrials.gov/ct2/show/ NCT03388970). And tranexamic acid is being tested for ICH by inhibiting haematoma expansion at phage 3 superiority trial (TICH2, ISRCTN93732214) [12]. Whereas, these clinical trials targeting on primary brain injury may reduce the hematoma growth, but cannot improve the functional outcomes of the patients. About 40% of the surviving patients bear obvious disabilities with the treatment o
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