Predictors of Hematoma Enlargement in Patients with Spontaneous Intracerebral Hemorrhage Treated with Rapid Administration of Antifibrinolytic Agents and Strict Conservative Management

Kim, Chang Hyeun; Lee, Sang Weon; Kim, Young Ha; Sung, Soon Ki; Son, Dong Wuk; Song, Geun Sung

Spontaneous intracerebral hemorrhage (ICH) is caused by the rupture of small blood vessels in the brain. It is a major health problem with an annual incidence of 10-30 per 100,000 individuals and accounts for 8-30% of total strokes. 23) Compared with ischemic stroke, ICH is a critical disease with 2-6 times higher mortality and morbidity. 12) According to reports, the 30-day mortality rate of ICH is 30-55% and only 12-39% of survivors have favorable functional outcomes after 6 months. 19, 24) In patients with ICH, hematoma enlargement is the most critical risk factor that causes poor outcomes and increasing mortality. 15 ) Therefore, prevention of hematoma enlargement is the goal of conservative management. However, except strict control of blood pressure (BP), it is not know how to prevent hematoma enlargement in ICH patients. 15, 18) According to several articles, the use of anti-fibrinolytic agents has been reported to reduce blood loss during surgery and prevent hematoma expansion. 1, 8, 11, 27, 32) However, unlike these promising findings, some related randomized controlled trial have shown that antifibrinolytic agents do not affect rebleeding, neurologic deterioration, and mortality for cerebral hemorrhage. 25, 29) In consideration of these discrepancies, we analyzed the risk factors for hematoma expansion in ICH patients and compared the predictability of hematoma expansion in ICH patients with the use of an anti-fibrinolytic agent.