How is Intracranial hemorrhage treated?
Intracranial hemorrhage are managed by reversing coagulopathy. Clot evacuation for lobar ICHs and ventriculostomy in cases with hydrocephalus or intraventricular blood may be considered.
Intraventricular clot lysis with tPA is being studied. High blood pressure is associated with hematoma expansion and rebleeding, so systolic blood pressure is maintained below 180 mm Hg.
The INTERACT (intensive blood pressure Reduction in Acute Cerebral haemorrhage Trial) and ATACH (Antihypertensive Treatment of Acute Cerebral Hemorrhage) trial have found that further lowering systolic blood pressure to 140 mm Hg is safe and feasible, but clinical benefit has not been demonstrated.
DVTs are common following ICH, and pneumatic compression devices are more effective than compression stockings alone.
Some practitioners add subcutaneous heparin after 48 hours.
