Intrazerebrale Blutung - Was gibt es Neues?

Zusammenfassung

Anfang 2005 wurden zwei multizentrische, randomisierte und kontrollierte Studien zur Therapie der spontanen intrazerebralen Blutung (ICB) veröffentlicht: Der International Surgical Trial in Intracerebral Haemorrhage (STICH) befasste sich mit dem Effekt einer frühen operativen Behandlung, die zweite Studie mit der Wirkung von aktiviertem rekombinantem Faktor VII bei ICBs. Wir fassen hier die wesentlichen Untersuchungsergebnisse dieser beiden Studien zusammen und diskutieren die Konsequenzen für die zukünftige Therapie und weitere klinische Studien. Dabei berücksichtigen wir gegenwärtige pathophysiologische Konzepte und Ergebnisse anderer Studien zur Behandlung der spontanen ICB.

Abstract

Two multicentre, randomized, controlled trials for the therapy of spontaneous intracerebral hemorrhage (ICH) were published at the beginning of 2005. The International Surgical Trial in Intracerebral Haemorrhage (STICH) investigated the effectiveness of early surgical intervention. The second trial investigated the effectiveness of activated recombinant factor VII (rFVIIa) to prevent rebleeding in acute ICH. The results of these trials are summarized. We discuss the consequences of the trials for future treatment and clinical trials in reflection of current pathophysiological concepts and other trials in ICH.

Literatur

• 1 Weimar C, Weber C, Wagner M. et al . Management patterns and health care use after intracerebral hemorrhage. A cost-of-illness study from a societal perspective in Germany.  Cerebrovasc Dis. 2003;  15 29-36
• 2 Broderick J, Brott T, Duldner J E. et al . Volume of intracrerbral hemorrhage: a powerful and easy-to-use predictor of 30-day mortality.  Stroke. 1993;  24 987-993
• 3 Fujii Y, Tanaka R, Takeuchi S. et al . Hematoma enlargement in spontaneous intracerebral hemorrhage.  J Neurosurg. 1994;  80 51-57
• 4 Fujitsu K, Muramoto M, Ikeda Y. et al . Indications for surgical treatment of putaminal hemorrhage. Comparative study based on serial CT and time-course analysis.  J Neurosurg. 1990;  73 518-525
• 5 Kazui S, Naritomi H, Yamamoto H. et al . Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course.  Stroke. 1996;  27 1783-1787
• 6 Brott T, Broderick J, Kothari R. et al . Early hemorrhage growth in patients with intracerebral hemorrhage.  Stroke. 1997;  28 1-5
• 7 Gebel Jr J M, Jauch E C, Brott T G. et al . Natural History of Perihematomal Edema in Patients With Hyperacute Spontaneous Intracerebral Hemorrhage.  Stroke. 2002;  33 2631-2635
• 8 Lee K R, Kawai N, Kim S. et al . Mechanisms of edema formation after intracerebral hemorrhage: effects of thrombin on cerebral blood flow, blood-brain barrier permeability, and cell survival in a rat model.  J Neurosurg. 1997;  86 272-278
• 9 Butcher K S, Baird T, MacGregor L. et al . Perihematomal edema in primary intracerebral hemorrhage is plasma derived.  Stroke. 2004;  35 1879-1885
• 10 Xi G. Intracerebral hemorrhage: pathophysiology and therapy.  Neurocritical Care. 2004;  1 5-18
• 11 Ropper A. Lateral displacement of the brain and level of consciousness in patients with acute hemispherical mass.  New England Journal of Medicine. 1986;  314 953-958
• 12 Qureshi A I, Tuhrim S, Broderick J P. et al . Spontaneous intracerebral hemorrhage.  N Engl J Med. 2001;  344 1450-1460
• 13 Tuhrim S, Horowitz D R, Sacher M. et al . Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage.  Crit Care Med. 1999;  27 617-621
• 14 Diringer M N, Edwards D F, Zazulia A R. Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage.  Stroke. 1998;  29 1352-1357
• 15 Konsensusgruppe Intrazerebrale Blutungen .Intrazerebrale Blutung. Leitlinien der Deutschen Gesellschaft für Neurologie (DGN). 2004; 2005
• 16 Schwarz S, Schmiedek P. Zerebrale Blutungen - Chirurgische Behandlung. In: Diener H-C, Hacke W, Forsting M (Hrsg) Referenzreihe Neurologie, Schlaganfall. Stuttgart; Georg Thieme Verlag 2003: 107-112
• 17 Mendelow A D, Gregson B A, Fernandes H M. et al . Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial.  Lancet. 2005;  9457 387-397
• 18 Shaw M D, Mendelow A D, Teasdale G M. et al . Alterations to STICH protocol.  Lancet. 2003;  362 1244
• 19 Mendelow A D. More conclusions from the International Surgical Trial in Intracerebral Haemorrhage (STICH). European Stroke Conference (ESC). Bologna; Virtual Stroke University 27.5.2005 http://stroke-university.com/view
• 20 Morgenstern L B, Frankowski R F, Shedden P. et al . Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial.  Neurology. 1998;  51 1359-1363
• 21 Morgenstern L B, Demchuk A M, Kim D H. et al . Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage.  Neurology. 2001;  56 1294-1299
• 22 Prasad K, Shrivastava A. Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database Syst Rev 2000 CD000200
• 23 Fernandez L, Norwood S, Roettger R. et al . Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients.  Archives of Surgery. 1996;  131 129-132
• 24 Roos Y B, Rinkel G J, Vermeulen M. et al .Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2003 CD001245
• 25 Kassell N F, Haley E C, Torner J C. Antifibrinolytic therapy in the treatment of aneurysmal subarachnoid hemorrhage.  Clin Neurosurg. 1986;  33 137-145
• 26 Roos Y. Antifibrinolytic treatment in subarachnoid hemorrhage: a randomized placebo-controlled trial. STAR Study Group.  Neurology. 2000;  54 77-82
• 27 Adams Jr H P, Nibbelink D W, Torner J C. et al . Antifibrinolytic therapy in patients with aneurysmal subarachnoid hemorrhage. A report of the cooperative aneurysm study.  Arch Neurol. 1981;  38 25-29
• 28 Vujkovac B, Sabovic M. Treatment of subdural and intracerebral haematomas in a haemodialysis patient with tranexamic acid.  Nephrol Dial Transplant. 2000;  15 107-109
• 29 Piriyawat P, Morgenstern L B, Yawn D. et al . Treatment of acute intracerebral hemorrhage with e-aminocaproic acid - a pilot study.  Neurocritical Care. 2004;  1 47-51
• 30 Hoffman M, Monroe 3rd D M. A cell-based model of hemostasis.  Thromb Haemost. 2001;  85 958-965
• 31 Hoffmann M, Monroe D M, Roberts H R. Activated factor VII activates factors IX and X on the surface of activated platelets: thoughts on the mechanism of action of high-dose activated VII.  Blood Coagul Fibrinolysis. 1998;  9 S61-S65
• 32 Mayer S, Brun N, Broderick J. et al . Safety and feasibility of recombinant factor VIIa for acute intracerebral hemorrhage.  Stroke. 2005;  36 74-79
• 33 Steiner T, Seremetis S, Skolnick B E. et al . Safety of recombinant coagulation factor VII in patients with acute intracerebral hemorrhage.  Cerebrovasc Dis. 2004;  17 67
• 34 Mayer S, Brun N, Broderick J. et al . Recombinant activated factor VII for acute intracerebral hemorrhage.  N Engl J Med. 2005;  352 777-785
• 35 Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials.  Arch Intern Med. 1994;  154 1449-1457
• 36 Go A S, Hylek E M, Phillips K A. et al . Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.  JAMA. 2001;  285 2370-2375
• 37 Rosand J, Eckman M H, Knudsen K A. et al . The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage.  Arch Intern Med. 2004;  164 880-884
• 38 Yasaka M, Minematsu K, Naritomi H. et al . Predisposing factors for enlargement of intracerebral hemorrhage in patients treated with warfarin.  Thromb Haemost. 2003;  89 278-283
• 39 Flibotte J J, Hagan N, O'Donnell J. et al . Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage.  Neurology. 2004;  63 1059-1064
• 40 Steiner T, Diringer M, Rosand J. Intracerebral hemorrhage associated with oral anticoagulant therapy: current practices and open questions.  Stroke. 2006;  37 256-262
• 41 Erhardtsen E, Nony P, Dechavanne M. et al . The effect of recombinant factor VIIa (NovoSeven) in healthy volunteers receiving acenocoumarol to an International Normalized Ration above 2.0.  Blood Coagul Fibrinolysis. 1998;  9 741-748
• 42 Park P, Fewel M E, Thompson B G. et al . Recombinant activated factor VII for the rapid correction of coagulopathy in nonhemophilic neurosurgical patients.  Neurosurgery. 2003;  53 34-38; discussion 38 - 39
• 43 Freeman W D, Brott T G, Barrett K M. et al . Recombinant factor VIIa for rapid reversal of warfarin anticoagulation in acute intracranial hemorrhage.  Mayo Clin Proc. 2004;  79 1495-1500
• 44 NINDS ICH Workshop Participants . Priorities for Clinical Research in Intracerebral Hemorrhage. Report From a National Institute of Neurologic Disorders and Stroke Workshop.  Stroke. 2005;  36 e23-e41