BACKGROUND: Intracerebral hemorrhage (ICH) is a devastating form of stroke for which the lack of treatment options, high mortality rate, and the tendency to severely disable result in high social and economic burden. METHODS: We analyzed data in the Registry of the Canadian Stroke Network (RCSN). We sought to: (1) provide a descriptive analysis of ICH; (2) determine the proportion of ICH patients that might have been eligible for treatment with recombinant activated factor VII (rFVIIa) using criteria from a recent phase II trial; (3) compare 6-month outcomes of ICH patients with those of ischemic stroke patients, matched for gender, age, and stroke severity. RESULTS: In the RCSN, 11% of all strokes were nontraumatic ICH. The median Canadian Neurological Scale score was 7. A minority (33%) of patients arrived to the emergency department in less than 3 h from onset. In this cohort, in-hospital mortality was 15%. At 6 months, a further 9% of patients had died and 58% had a slight to no disability (Stroke Impact Scale-16 score > or = 75). Approximately 20% of ICH patients would have been eligible for rFVIIa treatment. Compared to ischemic stroke, ICH showed a trend towards increased mortality at discharge (OR: 1.96, CI: 0.99-3.87). At 6-month follow-up, ICH showed increased mortality (OR: 2.27, CI: 1.29-3.97), yet functional outcomes were not significantly different. CONCLUSION: ICH patients had a higher case-fatality rate when compared to acute ischemic stroke, but survivors had similar functional outcomes. In Canada, about one fifth of ICH patients might potentially benefit from rFVIIa if it is approved, with the major exclusion factor being time. Copyright 2006 S. Karger AG, Basel.
BACKGROUND:Intracerebral hemorrhage (ICH) is a devastating form of stroke for which the lack of treatment options, high mortality rate, and the tendency to severely disable result in high social and economic burden. METHODS: We analyzed data in the Registry of the Canadian Stroke Network (RCSN). We sought to: (1) provide a descriptive analysis of ICH; (2) determine the proportion of ICHpatients that might have been eligible for treatment with recombinant activated factor VII (rFVIIa) using criteria from a recent phase II trial; (3) compare 6-month outcomes of ICHpatients with those of ischemic strokepatients, matched for gender, age, and stroke severity. RESULTS: In the RCSN, 11% of all strokes were nontraumatic ICH. The median Canadian Neurological Scale score was 7. A minority (33%) of patients arrived to the emergency department in less than 3 h from onset. In this cohort, in-hospital mortality was 15%. At 6 months, a further 9% of patients had died and 58% had a slight to no disability (Stroke Impact Scale-16 score > or = 75). Approximately 20% of ICHpatients would have been eligible for rFVIIa treatment. Compared to ischemic stroke, ICH showed a trend towards increased mortality at discharge (OR: 1.96, CI: 0.99-3.87). At 6-month follow-up, ICH showed increased mortality (OR: 2.27, CI: 1.29-3.97), yet functional outcomes were not significantly different. CONCLUSION:ICHpatients had a higher case-fatality rate when compared to acute ischemic stroke, but survivors had similar functional outcomes. In Canada, about one fifth of ICHpatients might potentially benefit from rFVIIa if it is approved, with the major exclusion factor being time. Copyright 2006 S. Karger AG, Basel.
Authors: Joshua N Goldstein; Louis E Fazen; Lauren Wendell; Yuchiao Chang; Natalia S Rost; Ryan Snider; Kristin Schwab; Rishi Chanderraj; Christopher Kabrhel; Catherine Kinnecom; Emilie Fitzmaurice; Eric E Smith; Steven M Greenberg; Jonathan Rosand Journal: Neurocrit Care Date: 2008-09-23 Impact factor: 3.210