Intracerebral hemorrhage (ICH) is associated with a higher mortality rate among stroke subtypes. The amount of hematoma at baseline and subsequent expansion are considered strong independent markers for determining poor clinical outcome. Even though reduction in blood pressure to prevent and control the amount of bleeding in ICH has received considerable amount of attention, the impact of coagulopathy and platelet dysfunction, on the bleeding diathesis has not been extensively investigated. With the increasing use of antiplatelets and/or anticoagulants, given the aging population, a deeper understanding of the interactions between ICH and hemostatic mechanisms is essential to help minimize the risk of a catastrophic coagulopathy-related ICH. In this review article, etiology and risk factors associated with coagulopathy-related ICH are discussed. An overview of coagulation abnormalities, hemostatic agents, and blood biomarkers pertaining to ICH is included.
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Intracerebral hemorrhage is a devastating condition that often results in high morbidity and mortality. Coagulopathy-associated ICH carries an even worse outcome due to larger hemorrhage size, expansion of hematoma, and ultimately higher mortality. Therefore, identifying patients with ICH having coagulopathy and its rapid reversal should be one of the main targets for this condition. The most promising agents for rapid reversal include rFVIIa and PCCs; however, randomized controlled trials have produced conflicting results. Therefore, further studies to determine the clinical utility of these agents in patients with ICH having coagulopathy are indicated. Finally, there have been very few studies with inadequate sample size, looking at the relation between coagulation markers and initial hematoma volume and its subsequent expansion. Accurate assessment of the relationship between these factors requires neuroimaging studies and blood tests at the early onset (<3 hours). The use of blood biomarkers to identify patients with ICH at higher risk of HE requires further investigation. Declaration of Conflicting Interests The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Nicole D. Zantek has an equity interest in Endo Health Solutions, which manufactures some of the products discussed in this manuscript. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: a generous support from Stanley S. Hubbard’s family.
- bleeding diathesis
- clinical outcome
- hematoma expansion
- intracerebral hemorrhage
- platelet dysfunction