Abstract
Intracerebral hemorrhage (ICH) is the second most prevalent type of stroke, after ischemic stroke, and has exceptionally high morbidity and mortality rates. After spontaneous ICH, one primary goal is to restrict hematoma expansion, and the second is to limit brain edema and secondary injury. Various types of transfusion therapies have been studied as treatment options to alleviate the adverse effects of ICH etiopathology. The objective of this work is to review transfusions with platelets, fresh frozen plasma (FFP), prothrombin complex concentrate (PCC), and red blood cells (RBCs) in patients with ICH. Furthermore, tranexamic acid infusion studies have been included due to its connection to ICH and hematoma expansion. As stated, the first line of therapy is limiting bleeding in the brain and hematoma expansion. Platelet transfusion is used to promote recovery and mitigate brain damage, notably in patients with severe thrombocytopenia. Additionally, tranexamic acid infusion, FFP, and PCC transfusion have been shown to affect hematoma expansion rate and volume. Although there is limited available research, RBC transfusions have been shown to cause higher tissue oxygenation and lower mortality, notably after brain edema, increases in intracranial pressure, and hypoxia. However, these types of transfusion have varied results depending on the patient, hemostasis status/blood thinner, hemolysis, anemia, and complications, among other variables. Inconsistencies in published results on various transfusion therapies led us to review the data and discuss issues that need to be considered when establishing future guidelines for patients with ICH.
Highlights
Intracerebral hemorrhage (ICH) is the second most prevalent type of stroke, behind ischemic stroke, and has exceptionally high morbidity and mortality rates, with 5.3 million cases and 3 million reported deaths worldwide in 2010
In a packed red blood cell (PRBC) transfusion study by Chang et al, the unadjusted cumulative logit model reported that the odds of being discharged with an modified Rankin Scale (mRS) of 5–6 were 9 times greater in transfused patients than in those who were not transfused (OR: 9.37, 95% CI: 2.84–30.88, p = 0.0002)
Some studies indicate that platelet transfusion is useful in promoting better patient outcomes; one study showed that it did not decrease in hematoma size
Summary
Intracerebral hemorrhage (ICH) is the second most prevalent type of stroke, behind ischemic stroke, and has exceptionally high morbidity and mortality rates, with 5.3 million cases and 3 million reported deaths worldwide in 2010. Case fatality rates reach nearly 60% at 1 year after stroke, and only 20% of patients who survive become independent within 6 months of injury [1]. ICH is the most common form of hemorrhagic stroke, resulting from bleeding in the brain tissue and ventricles and caused by hypertension, arteriovenous malformations, or head trauma. The primary injury leading to compression of the brain is the development of the hematoma, a collection of blood outside of blood vessels. The hematoma would increase the intracranial pressure (ICP), leading to brain hernias caused by a lack of blood flow [2]
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