Expansion in intracerebral hematoma.

Intracerebral hemorrhage (ICH) is the last stroke subtype without a primary therapy. The major research question is whether to treat the whole chain of disease events or just stabilize one link in the process. Several candidate events that would benefit from treatment exist: hemorrhage extension, mass effect-clot removal, or delayed edema-inflammation. In this issue of Neurocritical Care, Piriyawat et al. present a pilot study using two convenience samples of ICH patients exploring the idea that blood clot stabilization with antifibrinolytic drugs would limit the early expansion of hematomas. Two groups of patients were studied in sequence: nine ICH patients who experienced two episodes of hematoma expansion (HE) served as controls, demonstrating a baseline hematoma extension event rate of 22%. A second group of five ICH patients was treated in the first 12 hours after symptoms with the antifibrinolytic drug e-aminocaproic acid. Three of the treated patients experienced HE for an event rate of 60%. On first pass, it seems that clot stabilization is not likely to occur with eanimocaproic acid. The author's institutional IRB concluded that treatment in this protocol was futile and requested the study be stopped.