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S2k-Leitlinie: Behandlung von spontanen intrazerebralen Blutungen

Leitlinie der Deutschen Gesellschaft für Neurologie

S2k guideline: treatment of spontaneous intracerebral hemorrhage

Guideline of the German Society for Neurology

  • Leitlinie
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DGNeurologie Aims and scope

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Literatur

  1. Foerch C, Misselwitz B, Sitzer M et al (2008) Die Schlaganfallzahlen bis 2050. Dtsch Arztebl 105:467–473

    Google Scholar 

  2. Sacco S, Marini C, Toni D, Olivieri L, Carolei A (2009) Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke 40:394–399

    Article  PubMed  Google Scholar 

  3. Weir CJ, Murray GD, Adams FG et al (1994) Poor accuracy of stroke scoring systems for differential clinical diagnosis of intracranial haemorrhage and infarction. Lancet 344:999–1002

    Article  CAS  PubMed  Google Scholar 

  4. Al-Shahi Salman R, Frantzias J, Lee RJ et al (2018) Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurol 17:885–894

    Article  PubMed  PubMed Central  Google Scholar 

  5. Langhorne P, Fearon P, Ronning OM et al (2013) Stroke unit care benefits patients with Intracerebral hemorrhage: systematic review and meta-analysis. Stroke 44:30443049

    Article  Google Scholar 

  6. Anderson CS, Huang Y, Wang JG et al (2008) Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol 7:391–399

    Article  PubMed  Google Scholar 

  7. Anderson CS, Heeley E, Huang Y et al (2013) Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 368:2355–2365

    Article  CAS  PubMed  Google Scholar 

  8. Qureshi AI, Palesch YY, Barsan WG et al (2016) Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med 375:1033–1043

    Article  PubMed  PubMed Central  Google Scholar 

  9. Boulouis G, Morotti A, Goldstein JN, Charidimou A (2017) Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials. J Neurol Neurosurg Psychiatry 88:339–345

    Article  PubMed  Google Scholar 

  10. Burgess LG, Goyal N, Jones GM et al (2018) Evaluation of acute kidney injury and mortality after intensive blood pressure control in patients with Intracerebral hemorrhage. J Am Heart Assoc 7:1–11

    Article  CAS  Google Scholar 

  11. Li Q, Warren AD, Qureshi AI et al (2020) Ultra-early blood pressure reduction attenuates hematoma growth and improves outcome in intracerebral hemorrhage. Ann Neurol 88(2):388–395

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Graffagnino C, Bergese S, Love J et al (2013) Clevidipine rapidly and safely reduces blood pressure in acute Intracerebral hemorrhage: the ACCELERATE trial. Cerebrovasc Dis 36:173–180

    Article  CAS  PubMed  Google Scholar 

  13. Al-Shahi Salman R, Law ZK, Bath PM, Steiner T, Sprigg N (2018) Haemostatic therapies for acute spontaneous intracerebral haemorrhage. Cochrane Database Syst Rev 4(4):CD5951

    PubMed  Google Scholar 

  14. Imberti R, Pietrobono L, Klersy C et al (2012) Intraoperative intravenous administration of rFVIIa and hematoma volume after early surgery for spontaneous intracerebral hemorrhage: a randomized prospective phase II study. Minerva Anestesiol 78:168–175

    CAS  PubMed  Google Scholar 

  15. Wang YQ, Li X (2012) Intervention study on recombinant activated factor VIIa in depressing early hematoma extensions of cerebral hemorrhage. Chin J New Drugs 21:161–163

    Google Scholar 

  16. Mayer S, Brun N, Broderick J et al (2005) Safety and feasibility of recombinant factor VIIa for acute intracerebral hemorrhage. Stroke 36:74–79

    Article  CAS  PubMed  Google Scholar 

  17. Mayer SA, Brun NC, Begtrup K et al (2008) Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 358:21272137

    Article  Google Scholar 

  18. Mayer SA, Brun NC, Broderick J et al (2006) Recombinant activated factor VII for acute intracerebral hemorrhage: US phase IIA trial. Neurocrit Care 4:206–214

    Article  CAS  PubMed  Google Scholar 

  19. Mayer S, Brun N, Broderick J et al (2005) Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 352:777–785

    Article  CAS  PubMed  Google Scholar 

  20. Arumugam A, Rahman NAA, Theophilus SC, Shariffudin A, Abdullah JM (2015) Tranexamic acid as antifibrinolytic agent in non traumatic intracerebral hemorrhages. Malays J Med Sci 22:62–71

    PubMed  PubMed Central  Google Scholar 

  21. Sprigg N, Renton CJ, Kwong Y, Dineen RA, Bath P (2012) Tranexamic acid for acute intracerebral haemorrhage (TICH): results of the first randomised controlled trial. Int J Stroke 2:7

    Google Scholar 

  22. Zazulia AR Antifibrinolytic therapy in acute intracerebral hemorrhage. www.strokecenter.org. Zugegriffen: 27. Nov. 2017

  23. Baharoglu MI, Cordonnier C, Salman RA et al (2016) Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 387:2605–2613

    Article  PubMed  Google Scholar 

  24. Boulis NM, Bobek MP, Schmaier A, Hoff JT (1999) Use of factor IX complex in warfarin-related intracranial hemorrhage. Neurosurgery 45:1113–1118 (discussion 1118–1119)

    Article  CAS  PubMed  Google Scholar 

  25. Sprigg N, Flaherty K, Appleton JP et al (2018) Tranexamic acid for hyperacute primary intracerebral haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet 391:2107–2115

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Flibotte JJ, Hagan N, O’Donnell J, Greenberg SM, Rosand J (2004) Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage. Neurology 63:1059–1064

    Article  CAS  PubMed  Google Scholar 

  27. Steiner T, Poli S, Griebe M et al (2016) Fresh frozen plasma versus prothrombin complex concentrate in patients with intracranial haemorrhage related to vitamin K antagonists (INCH): a randomised trial. Lancet Neurol 15:566–573

    Article  CAS  PubMed  Google Scholar 

  28. Pollack CV Jr., Reilly PA, Eikelboom J et al (2017) Idarucizumab for dabigatran reversal—full cohort analysis. N Engl J Med 377:431–441

    Article  CAS  PubMed  Google Scholar 

  29. Connolly SJ, Crowther M, Eikelboom JW et al (2019) Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med 380:1326–1335

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Grau A, Steiner T et al (2019) Stellungnahme der DSG zum Einsatz von Andexanet Alpha. DSG,

    Google Scholar 

  31. EMA (2019) Ondexxya Anhang I: Zusammenfassung der Merkmale des Arzneimittels

    Google Scholar 

  32. Zahir H, Brown KS, Vandell AG et al (2015) Edoxaban effects on bleeding following punch biopsy and reversal by a 4-factor prothrombin complex concentrate. Circulation 131:82–90

    Article  CAS  PubMed  Google Scholar 

  33. Prasad K, Mendelow AD, Gregson B (2008) Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database Syst Rev 4:CD200

    Google Scholar 

  34. Mendelow AD, Gregson B (2011) Surgery for intracerebral haemorrhage. In: Mohr JP (Hrsg) Stroke—pathophysiology, diagnosis, and management with expert consult. Elsevier Saunders, Philadelphia

    Google Scholar 

  35. Mendelow AD, Gregson BA, Fernandes HM et al (2005) 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 9457:387–397

    Article  Google Scholar 

  36. Mendelow AD, Gregson BA, Rowan EN et al (2013) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 382:397–408

    Article  PubMed  PubMed Central  Google Scholar 

  37. Gregson BA, Mitchell P, Mendelow AD (2019) Surgical decision making in brain hemorrhage. Stroke 50:1108–1115

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sondag L, Schreuder F, Boogaarts HD et al (2020) Neurosurgical intervention for supratentorial intracerebral hemorrhage. Ann Neurol 88(2):239–250

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hanley DF, Thompson RE, Muschelli J, et al (2016) Safety and efficacy of minimally invasive surgery plus alteplase in intracerebral haemorrhage evacuation (MISTIE): a randomised, controlled, open-label, phase 2 trial. Lancet Neurol 15:1228–1237

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Hanley DF, Thompson RE, Rosenblum M, et al (2019) Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 393:1021–1032

    Article  PubMed  PubMed Central  Google Scholar 

  41. Tuhrim S, Horowitz DR, Sacher M, Godbold JH (1999) Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med 27:617–621

    Article  CAS  PubMed  Google Scholar 

  42. Hanley DF, Lane K, McBee N et al (2017) Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial. Lancet 389:603–611

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Staykov D, Kuramatsu JB, Bardutzky J et al (2016) Efficacy and safety of combined intraventricular fibrinolysis with lumbar drainage for prevention of permanent shunt dependency after intracerebral hemorrhage with severe ventricular involvement: A randomized trial and individual patient data meta-analysis. Ann Neurol 81:93–103

    Article  CAS  Google Scholar 

  44. Mokri B (2001) The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology 56:1746–1748

    Article  CAS  PubMed  Google Scholar 

  45. Bullock R, Golek J, Blake G (1989) Traumatic intracerebral hematoma—which patients should undergo surgical evacuation? CT scan features and ICP monitoring as a basis for decision making. Surg Neurol 32:181–187

    Article  CAS  PubMed  Google Scholar 

  46. Constantini S, Cotev S, Rappaport ZH et al (1988) Intracranial pressure monitoring after elective intracranial surgery. A retrospective study of 514 patients. J Neurosurg 69:540–544

    Article  CAS  PubMed  Google Scholar 

  47. Hawryluk GWJ, Nielson JL, Huie JR et al (2020) Analysis of normal high-frequency intracranial pressure values and treatment threshold in neurocritical care patients: insights into normal values and a potential treatment threshold. JAMA Neurol 77(9):11501158

    Article  Google Scholar 

  48. Ziai WC, Thompson CB, Mayo S et al (2019) Intracranial hypertension and cerebral perfusion pressure insults in adult hypertensive intraventricular hemorrhage: occurrence and associations with outcome. Crit Care Med 47:1125–1134

    Article  PubMed  PubMed Central  Google Scholar 

  49. Che XR, Wang YJ, Zheng HY (2020) Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery. World J Emerg Med 11:169–173

    Article  PubMed  PubMed Central  Google Scholar 

  50. Chen CJ, Ding D, Ironside N et al (2019) Intracranial pressure monitoring in patients with spontaneous intracerebral hemorrhage. J Neurosurg 132(6):1854–1864. https://doi.org/10.3171/2019.3.JNS19545

    Article  PubMed  Google Scholar 

  51. Kuramatsu JB, Biffi A, Gerner ST et al (2019) Association of surgical hematoma evacuation vs conservative treatment with functional outcome in patients with cerebellar Intracerebral hemorrhage. JAMA 322:1392–1403

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kuramatsu JB, Gerner ST, Schellinger PD et al (2015) Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA 313:824–836

    Article  CAS  PubMed  Google Scholar 

  53. Kuramatsu JB, Sembill JA, Gerner ST et al (2018) Management of therapeutic anticoagulation in patients with intracerebral haemorrhage and mechanical heart valves. Eur Heart J 39:1709–1723

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Gerner ST, Kuramatsu JB, Sembill JA et al (2018) Association of prothrombin complex concentrates administration and hematoma enlargement in NOAC-related intracerebral hemorrhage. Ann Neurol 83:186–196

    Article  CAS  PubMed  Google Scholar 

  55. Sprugel MI, Kuramatsu JB, Gerner ST et al (2018) Antiplatelet therapy in primary spontaneous and oral anticoagulation-associated intracerebral hemorrhage. Stroke 49:2621–2629

    Article  PubMed  Google Scholar 

  56. Woo D, Rosand J, Kidwell C et al (2013) The ethnic/racial variations of intracerebral hemorrhage (ERICH) study protocol. Stroke 44:e120–125

    Article  PubMed  Google Scholar 

  57. Chen R, Wang X, Anderson CS et al (2019) Infratentorial intracerebral hemorrhage. Stroke 50:1257–1259

    Article  PubMed  Google Scholar 

  58. Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC (2008) Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis. Stroke 39:3029–3035

    Article  PubMed  Google Scholar 

  59. den Hertog HM, van der Worp HB, van Gemert HM et al (2009) The paracetamol (acetaminophen) in stroke (PAIS) trial: a multicentre, randomised, placebo-controlled, phase III trial. Lancet Neurol 8:434–440

    Article  CAS  Google Scholar 

  60. Netherlands Trial Register (2010) Paracetamol (acetaminophen) in stroke 2 (PAIS 2): a randomized clinical trial to investigate the effect of high-dose paracetamol in patients with acute stroke and a body temperature of 37,0 °C or above. http://www.trialregister.nl/trialreg/admin/rctview.asp. Zugegriffen: 26. Sep. 2021

  61. Broessner G, Beer R, Lackner P et al (2009) Prophylactic, endovascularly based, long-term normothermia in ICU patients with severe cerebrovascular disease: bicenter prospective, randomized trial. Stroke 40:e657–665

    Article  PubMed  Google Scholar 

  62. Kollmar R, Schellinger P, Schwab S (2008) Hypothermia and decompression after intracerebral hemorrhage (HyDe-H). 17th European Stroke Conference (ESC), Nizza

    Google Scholar 

  63. Zhang XM, Li XL, Tang SH, Liu QC (2006) Effect of head hypothermia on serum inflammatory cytokines levels in patients with hypertensive intracerebral hemorrhage. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 18:294–296

    PubMed  Google Scholar 

  64. Dohi K, Jimbo H, Ikeda Y et al (2006) Pharmacological brain cooling with indomethacin in acute hemorrhagic stroke: antiinflammatory cytokines and antioxidative effects. Acta Neurochir Suppl 96:57–60

    Article  CAS  PubMed  Google Scholar 

  65. Su Z‑Q, Wang Y, Zhao Q‑J et al (2004) Recent effect of local mild hypothermia for improving neurological deficits in patients with cerebral hemorrhage. Chin J Clin Rehabil 8:1816–1817

    Google Scholar 

  66. Fu X‑H, Sun J, Li H‑P (2005) Functional prognosis affected by temperature control treatment in the near future in patients with stroke. Zhongguo Li Chuan Kung Fu 9:4–5

    Google Scholar 

  67. Diringer MN (2004) Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med 32:559–564

    Article  PubMed  Google Scholar 

  68. Huang H, Liu F, Zhan R (2003) Treatment of hypertensive cerebral hemorrhage by early-used mild hypothermia. Zhejiang Med J 25:326–327

    Google Scholar 

  69. Kollmar R, Staykov D, Dorfler A et al (2010) Hypothermia reduces perihemorrhagic edema after intracerebral hemorrhage. Stroke 41:1684–1689

    Article  PubMed  Google Scholar 

  70. Feng H, Shi D, Wang D et al (2002) Effect of local mild hypothermia on treatment of acute intracerebral hemorrhage, a clinical study. Zhonghua Yi Xue Za Zhi 82:1622–1624

    PubMed  Google Scholar 

  71. Xu L, Li X, Zhang X (2002) Clinical efficacy of head mild hypothermia in treatment of hypertensive intracerebral haemorrhage. Chin J Geriatr Cardiovasc Cerebrovasc Dis 4:327–329

    Google Scholar 

  72. Kallmunzer B, Krause C, Pauli E et al (2011) Standardized antipyretic treatment in stroke: a pilot study. Cerebrovasc Dis 31:382–389

    Article  PubMed  CAS  Google Scholar 

  73. Penner M, Silasi G, Wowk S, Warkentin L, Colbourne F (2011) Brief hyperthermia does not worsen outcome after striatal hemorrhage in rats. Curr Neurovasc Res 8:35–43

    Article  PubMed  Google Scholar 

  74. Abdullah JM, Husin A (2011) Intravascular hypothermia for acute hemorrhagic stroke: a pilot study. Acta Neurochir Suppl 111:421–424

    Article  PubMed  Google Scholar 

  75. Lacut K, Bressollette L, Le Gal G et al (2005) Prevention of venous thrombosis in patients with acute intracerebral hemorrhage. Neurology 65:865–869

    Article  CAS  PubMed  Google Scholar 

  76. Orken DN, Kenangil G, Ozkurt H et al (2009) Prevention of deep venous thrombosis and pulmonary embolism in patients with acute intracerebral hemorrhage. Neurologist 15:329–331

    Article  PubMed  Google Scholar 

  77. Paciaroni M, Agnelli G, Venti M et al (2011) Efficacy and safety of anticoagulants in the prevention of venous thromboembolism in patients with acute cerebral hemorrhage: a meta-analysis of controlled studies. J Thromb Haemost 9:893–898

    Article  CAS  PubMed  Google Scholar 

  78. Dennis M, Sandercock PA, Reid J et al (2009) Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet 373:1958–1965

    Article  CAS  PubMed  Google Scholar 

  79. Boeer A, Voth E, Henze T, Prange HW (1991) Early heparin therapy in patients with spontaneous intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 54:466–467

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Passero S, Rocchi R, Rossi S, Ulivelli M, Vatti G (2002) Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia 43:1175–1180

    Article  PubMed  Google Scholar 

  81. Alberti A, Paciaroni M, Caso V et al (2008) Early seizures in patients with acute stroke: frequency, predictive factors, and effect on clinical outcome. Vasc Health Risk Manag 4:715–720

    Article  PubMed  PubMed Central  Google Scholar 

  82. Bladin CF, Alexandrov AV, Bellavance A et al (2000) Seizures after stroke: a prospective multicenter study. Arch Neurol 57:1617–1622

    Article  CAS  PubMed  Google Scholar 

  83. Arboix A, Garcia-Eroles L, Massons JB, Oliveres M, Comes E (1997) Predictive factors of early seizures after acute cerebrovascular disease. Stroke 28:1590–1594

    Article  CAS  PubMed  Google Scholar 

  84. Giroud M, Gras P, Fayolle H et al (1994) Early seizures after acute stroke: a study of 1,640 cases. Epilepsia 35:959–964

    Article  CAS  PubMed  Google Scholar 

  85. Burneo JG, Fang J, Saposnik G (2010) Impact of seizures on morbidity and mortality after stroke: a Canadian multi-centre cohort study. Eur J Neurol 17:52–58

    Article  CAS  PubMed  Google Scholar 

  86. Garrett MC, Komotar RJ, Starke RM et al (2009) Predictors of seizure onset after intracerebral hemorrhage and the role of long-term antiepileptic therapy. J Crit Care 24:335–339

    Article  PubMed  Google Scholar 

  87. Desai P, Prasad K (1998) Dexamethasone is not necessarily unsafe in primary supratentorial intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 65:799–800

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Hooshmand H, Quinn JC, Houff SA (1972) Cerebrospinal fluid pressure changes with chemotherapy for intracerebral hemorrhage. Neurology 22:56–61

    Article  CAS  PubMed  Google Scholar 

  89. Ogun SA, Odusote KA (2001) Effectiveness of high dose dexamethasone in the treatment of acute stroke. West Afr J Med 20:1–6

    CAS  PubMed  Google Scholar 

  90. Poungvarin N, Bhoopat W, Viriyavejakul A et al (1987) Effects of dexamethasone in primary supratentorial intracerebral hemorrhage. N Engl J Med 316:1229–1233

    Article  CAS  PubMed  Google Scholar 

  91. Tellez H, Bauer RB (1973) Dexamethasone as treatment in cerebrovascular disease. 1. A controlled study in intracerebral hemorrhage. Stroke 4:541–546

    Article  CAS  PubMed  Google Scholar 

  92. Feigin VL, Anderson NE, Rinkel GJE et al (2005) Corticosteroids for aneurysmal subarachnoid hemorrhage and primary intracerebral hemorrhage. Cochrane Database Syst Rev 3:CD4583

    Google Scholar 

  93. Sharafadinzadeh N, Baghebanian SM, Pipelzadeh M, Maravej AAA, Ghanavati P (2008) Effects of dexamethasone in primary intracerebral hemorrhage in the south west of Iran. Pak J Med Sci 24:502–505

    Google Scholar 

  94. Hemphill JC 3rd, Farrant M, Neill TA Jr. (2009) Prospective validation of the ICH Score for 12-month functional outcome. Neurology 73:1088–1094

    Article  PubMed  PubMed Central  Google Scholar 

  95. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC (2001) The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 32:891–897

    Article  PubMed  Google Scholar 

  96. Naidech AM, Bernstein RA, Bassin SL et al (2009) How patients die after intracerebral hemorrhage. Neurocrit Care 11:45–49

    Article  PubMed  Google Scholar 

  97. Hemphill JC 3rd, Newman J, Zhao S, Johnston SC (2004) Hospital usage of early do-not-resuscitate orders and outcome after intracerebral hemorrhage. Stroke 35:1130–1134

    Article  PubMed  Google Scholar 

  98. Becker KJ, Baxter AB, Cohen WA et al (2001) Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology 56:766–772

    Article  CAS  PubMed  Google Scholar 

  99. Creutzfeldt CJ, Becker KJ, Weinstein JR et al (2011) Do-not-attempt-resuscitation orders and prognostic models for intraparenchymal hemorrhage. Crit Care Med 39:158–162

    Article  PubMed  PubMed Central  Google Scholar 

  100. Siegel MD (2009) End-of-life decision making in the ICU. Clin Chest Med 30:181–194

    Article  PubMed  Google Scholar 

  101. Carrese JA, Sugarman J (2006) The inescapable relevance of bioethics for the practicing clinician. Chest 130:1864–1872

    Article  PubMed  Google Scholar 

  102. Rydvall A, Lynoe N (2008) Withholding and withdrawing life-sustaining treatment: a comparative study of the ethical reasoning of physicians and the general public. Crit Care 12:R13

    Article  PubMed  PubMed Central  Google Scholar 

  103. Broderick J, Brott T, Duldner JE, Tomsick T, Huster G (1993) Volume of intracerebral hemorrhage: a powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993

    Article  CAS  PubMed  Google Scholar 

  104. Diringer MN, Edwards DF, Zazulia AR (1998) Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke 29:1352–1357

    Article  CAS  PubMed  Google Scholar 

  105. Zahuranec DB, Brown DL, Lisabeth LD et al (2007) Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology 68:1651–1657

    Article  CAS  PubMed  Google Scholar 

  106. Bardach N, Zhao S, Pantilat S, Johnston SC (2005) Adjustment for do-not-resuscitate orders reverses the apparent in-hospital mortality advantage for minorities. Am J Med 118:400–408

    Article  PubMed  Google Scholar 

  107. Zahuranec DB, Brown DL, Lisabeth LD et al (2009) Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage. Crit Care Med 37:2807–2811

    Article  PubMed  PubMed Central  Google Scholar 

  108. PROGRESS Collaborative Group. (2001) Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 358:1033–1041

    Article  Google Scholar 

  109. Arima H, Tzourio C, Anderson C et al (2010) Effects of perindopril-based lowering of blood pressure on intracerebral hemorrhage related to amyloid angiopathy: the PROGRESS trial. Stroke 41:394–396

    Article  CAS  PubMed  Google Scholar 

  110. Kizer JR, Dahlof B, Kjeldsen SE et al (2005) Stroke reduction in hypertensive adults with cardiac hypertrophy randomized to losartan versus atenolol: the losartan intervention for endpoint reduction in hypertension study. Hypertension 45:46–52

    Article  CAS  PubMed  Google Scholar 

  111. Perry HM Jr., Davis BR, Price TR et al (2000) Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the systolic hypertension in the elderly program (SHEP). JAMA 284:465–471

    Article  PubMed  Google Scholar 

  112. Jamerson K, Weber MA, Bakris GL et al (2008) Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 359:2417–2428

    Article  CAS  PubMed  Google Scholar 

  113. Dahlof B, Sever PS, Poulter NR et al (2005) Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian cardiac outcomes trial-blood pressure lowering arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 366:895–906

    Article  PubMed  CAS  Google Scholar 

  114. Arguedas JA, Perez MI, Wright JM (2009) Treatment blood pressure targets for hypertension. Cochrane Database Syst Rev 3:CD4349

    Google Scholar 

  115. Shoamanesh A (2020) NOACs for stroke prevention in patients with atrial fibrillation and previous ICH (NASPAF-ICH)

    Google Scholar 

  116. Koen M et al (2015) Apixaban versus antiplatelet drugs or no antithrombotic drugs after anticoagulation-associated Intracerebral haemorrhage in patients with atrial fibrillation (APACHE-AF)

    Google Scholar 

  117. Al-Shahi Salman R (2020) NCT03153150—start or stop anticoagulants randomised trial (soSTART) (soSTART). https://clinicaltrials.gov/ct2/show/NCT03153150. Zugegriffen: 26. Sep. 2021

  118. Cordonnier C (2020) NCT03243175—avoiding anticoagulation after intracerebral haemorrhage (A3ICH). https://clinicaltrials.gov/ct2/show/NCT03243175. Zugegriffen: 26. Sep. 2021

  119. Wyller TB (2020) NCT03186729—study of antithrombotic treatment after intracerebral haemorrhage (STATICH). https://clinicaltrials.gov/ct2/show/NCT03186729. Zugegriffen: 26. Sep. 2021

  120. Rosenqvist M (2020) NCT02830152—prevention of stroke by left atrial appendage closure in atrial fibrillation patients after Intracerebral hemorrhage (STROKECLOSE). https://clinicaltrials.gov/ct2/show/NCT03186729. Zugegriffen: 26. Sep. 2021

  121. Veltkamp R (2020) PREvention of STroke in Intracerebral haemorrhaGE survivors with atrial fibrillation (PRESTIGE-AF). https://clinicaltrials.gov/ct2/show/NCT03996772. Zugegriffen: 26. Sep. 2021

  122. Sehth K (2020) NCT03907046—anticoagulation in ICH survivors for stroke prevention and recovery (ASPIRE). https://clinicaltrials.gov/ct2/show/NCT03907046. Zugegriffen: 26. Sep. 2021

  123. Biffi A, Kuramatsu JB, Leasure A et al (2017) Oral anticoagulation and functional outcome after intracerebral hemorrhage. Ann Neurol 82:755–765

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  124. Murthy SB, Gupta A, Merkler AE et al (2017) Restarting anticoagulant therapy after intracranial hemorrhage: a systematic review and meta-analysis. Stroke 48:1594–1600

    Article  PubMed  PubMed Central  Google Scholar 

  125. Pennlert J, Overholser R, Asplund K et al (2017) Optimal timing of anticoagulant treatment after intracerebral hemorrhage in patients with atrial fibrillation. Stroke 48:314–320

    Article  PubMed  Google Scholar 

  126. Wilson D, Ambler G, Shakeshaft C et al (2018) Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study. Lancet Neurol 17:539–547

    Article  PubMed  PubMed Central  Google Scholar 

  127. Sahay S, Nombela-Franco L, Rodes-Cabau J et al (2017) Efficacy and safety of left atrial appendage closure versus medical treatment in atrial fibrillation: a network meta-analysis from randomised trials. Heart 103:139–147

    Article  CAS  PubMed  Google Scholar 

  128. Reddy VY, Doshi SK, Kar S, Gibson DN, Price MJ, Huber K, et al (2017) 5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials. J Am Coll Cardiol 70:2964–2975

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neurologische Klinik, Klinikum Frankfurt Höchst, Frankfurt, Deutschland

    Thorsten Steiner MME

  2. Neurologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Thorsten Steiner MME

  3. Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Andreas Unterberg

Authors
  1. Thorsten Steiner MME
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Correspondence to Thorsten Steiner MME or Andreas Unterberg.

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Interessenkonflikt

Siehe Interessenkonflikterklärung auf www.dgn.org/leitlinien.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

P. Berlit, Berlin

Fachgesellschaft

Deutsche Gesellschaft für Neurologie (DGN)

Federführend

Prof. Dr. Thorsten Steiner MME, Neurologische Klinik, Klinikum Frankfurt Höchst, Frankfurt; Neurologische Klinik, Universitätsklinikum Heidelberg

thorsten_steiner@med.uni-heidelberg.de

Prof. Dr. Andreas Unterberg, Neurochirurgische Klinik, Universitätsklinikum Heidelberg

andreas.unterberg@med.uni-heidelberg.de

Redaktionskomitee

PD Dr. Ronny Beer, Neurologische Klinik, Universitätsklinikum Innsbruck, Österreich

Prof. Dr. Martin Bendszus, Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg

Prof. Dr. Martin Dichgans, Institut für Schlaganfall und Demenzforschung, Interdisziplinäres Schlaganfallzentrum, LMU Klinikum München

Prof. Gerhard F. Hamann, Neurologische Klinik, Klinikum Günzburg, Günzburg

Prof. Dr. Krassen Nedeltchev, Neurologische Klinik, Klinikum Aarau, Schweiz

Prof. Dr. Stefan Schwab, Neurologische Klinik, Universitätsklinikum Erlangen

Prof. Dr. Volker Seifert, Neurochirurgische Klinik, Universitätsklinikum Frankfurt

Prof. Dr. Thorsten Steiner MME, Neurologische Klinik, Klinikum Frankfurt Höchst, Frankfurt; Neurologische Klinik, Universitätsklinikum Heidelberg

Prof. Dr. Andreas Unterberg, Neurochirurgische Klinik, Universitätsklinikum Heidelberg

Dr. Markus Wagner, Stiftung Deutsche Schlaganfall-Hilfe, Gütersloh

Beteiligte Fachgesellschaften und Organisationen

„European Stroke Organisation“ (ESO)

Deutsche Gesellschaft für Neurointensiv- und Notfallmedizin (DGNI)

Deutsche Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurologie (DGN)

Deutsche Gesellschaft für Neuroradiologie (DGNR)

Deutsche Schlaganfall-Gesellschaft (DSG)

Österreichische Gesellschaft für Neurologie (ÖGN)

Schweizerische Neurologische Gesellschaft (SNG)

Stiftung Deutsche Schlaganfall-Hilfe

Die vollständige Leitlinie wurde am 09.06.2021 unter https://dgn.org/leitlinien/ll-030-002-behandlung-von-spontanen-intrazerebralen-blutungen/ publiziert.

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Steiner, T., Unterberg, A. S2k-Leitlinie: Behandlung von spontanen intrazerebralen Blutungen. DGNeurologie 4, 457–480 (2021). https://doi.org/10.1007/s42451-021-00381-z

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