Hemostatic Therapy Should Not Be Used for Acute Treatment of Anticoagulation-Related Intracerebral Hemorrhage

Abstract

“Just say no” was the slogan used in a US advertising campaign in the mid-1980s discouraging young people from engaging in recreational and potentially harmful drug use. In the context of this controversy, the same motto comes to mind when considering the routine use of conceptually exciting but medically unproven therapies outside the setting of controlled clinical studies. Trial-and-error treatment strategies and off-label therapies are even more worrisome in a situation in which the patient's clinical status is insufficiently defined. In the abstracted case description, the side of the hemorrhage is unknown, and other than being qualified as “lobar,” no details are provided on hematoma location and potential ventricular extension. More importantly, the patient's neurological deficit and crucial vital parameters (such as blood pressure, body temperature) are unknown. Assuming that no potentially negative outcome predictor has been cited simply because there is none, the patient's “intracerebral hemorrhage (ICH) score” is 0 leading to an estimated 30-day mortality risk trending toward zero.1 An immediate indication for any surgical rescue procedure (such …