Template:ICH Treatment - Revision history

Danbot: Convert BP control, TXA, and desmopressin dosing to MedicationDose templates for SMW integration

2026-03-20T22:32:31Z

Convert BP control, TXA, and desmopressin dosing to MedicationDose templates for SMW integration

← Revisión anterior		Revisión del 22:32 20 mar 2026
Línea 17:		Línea 17:


	*[[Nicardipine~~]] in ICH: Start at 5mg~~/hr, ~~increase~~ 2.~~5mg~~ q5min ~~until the target blood pressure is achieved and then immediately titrate~~ down to ~~maintenance infusion of 3mg~~/hr.		*{{MedicationDose\|drug=Nicardipine\|dose=5-15 mg/hr IV, titrate by 2.5 mg q5min\|route=IV drip\|context=BP control in ICH\|indication={{PAGENAME}}\|population=Adult\|notes=Titrate down to 3 mg/hr maintenance once target achieved}}
	*[[Labetalol~~]] in ICH: 20mg~~ bolus ~~over 1-2 minutes~~, repeat q3-5 ~~mins until target blood pressure is achieved and~~ then ~~start an infusion of~~ 1-~~8mg~~/min.		*{{MedicationDose\|drug=Labetalol\|dose=20 mg IV bolus, repeat q3-5 min; then 1-8 mg/min drip\|route=IV\|context=BP control in ICH\|indication={{PAGENAME}}\|population=Adult}}

	===Reverse coagulopathy===		===Reverse coagulopathy===
	[[File:Harobr tICH algorithm.png\|thumb\|Example ''traumatic'' ICH coagulopathy reversal algorithm.]]		[[File:Harobr tICH algorithm.png\|thumb\|Example ''traumatic'' ICH coagulopathy reversal algorithm.]]
	*See [[anticoagulant reversal for life-threatening bleeds]] if on a known anticoagulant (e.g. [[heparin]], [[coumadin]], [[rivaroxaban]])		*See [[anticoagulant reversal for life-threatening bleeds]] if on a known anticoagulant (e.g. [[heparin]], [[coumadin]], [[rivaroxaban]])
	*[[Tranexamic acid]] 1g (if within 3 ~~hours~~ of event), ~~followed by an additional~~ 1g ~~infused~~ over 8 ~~hours~~ <ref>[[EBQ:CRASH-3 Trial\|Crash-3 Trial]]</ref>		*{{MedicationDose\|drug=Tranexamic acid\|dose=1g IV (within 3 hrs of event), then 1g over 8 hrs\|route=IV\|context=Coagulopathy reversal in ICH\|indication={{PAGENAME}}\|population=Adult}} <ref>[[EBQ:CRASH-3 Trial\|Crash-3 Trial]]</ref>

	====Antiplatelet Reversal====		====Antiplatelet Reversal====
	''Includes [[aspirin]], [[prasugrel]], [[clopidogrel]]''		''Includes [[aspirin]], [[prasugrel]], [[clopidogrel]]''
	*Consider ~~[[desmopressin]] (~~0.~~3mcg~~/kg)		*Consider {{MedicationDose\|drug=Desmopressin\|dose=0.3 mcg/kg IV\|route=IV\|context=Antiplatelet reversal in ICH\|indication={{PAGENAME}}\|population=Adult}}
	*Platelet transfusion		*Platelet transfusion
	**No known thrombocytopenia: ''increases'' mortality; do '''NOT''' give<ref>[[EBQ:Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial\|(PATCH trial)]]</ref>		**No known thrombocytopenia: ''increases'' mortality; do '''NOT''' give<ref>[[EBQ:Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial\|(PATCH trial)]]</ref>
	**Known or diagnosed thrombocytopenia: consider if platelets <50,000		**Known or diagnosed thrombocytopenia: consider if platelets <50,000
	***Some hematologists and neurosurgeons recommend for <100,000, despite lack of evidence for improved outcomes		***Some hematologists and neurosurgeons recommend for <100,000, despite lack of evidence for improved outcomes

Rossdonaldson1: /* Reverse coagulopathy */

2025-02-26T16:40:32Z

Reverse coagulopathy

← Revisión anterior		Revisión del 16:40 26 feb 2025
Línea 21:		Línea 21:

	===Reverse coagulopathy===		===Reverse coagulopathy===
	[[File:Harobr tICH algorithm.png\|thumb\|Example coagulopathy reversal algorithm.]]		[[File:Harobr tICH algorithm.png\|thumb\|Example ''traumatic'' ICH coagulopathy reversal algorithm.]]
	*See [[anticoagulant reversal for life-threatening bleeds]] if on a known anticoagulant (e.g. [[heparin]], [[coumadin]], [[rivaroxaban]])		*See [[anticoagulant reversal for life-threatening bleeds]] if on a known anticoagulant (e.g. [[heparin]], [[coumadin]], [[rivaroxaban]])
	*[[Tranexamic acid]] 1g (if within 3 hours of event), followed by an additional 1g infused over 8 hours <ref>[[EBQ:CRASH-3 Trial\|Crash-3 Trial]]</ref>		*[[Tranexamic acid]] 1g (if within 3 hours of event), followed by an additional 1g infused over 8 hours <ref>[[EBQ:CRASH-3 Trial\|Crash-3 Trial]]</ref>

Rossdonaldson1: /* Reverse coagulopathy */

2025-02-26T16:39:56Z

Reverse coagulopathy

← Revisión anterior		Revisión del 16:39 26 feb 2025
Línea 21:		Línea 21:

	===Reverse coagulopathy===		===Reverse coagulopathy===
			[[File:Harobr tICH algorithm.png\|thumb\|Example coagulopathy reversal algorithm.]]
	*See [[anticoagulant reversal for life-threatening bleeds]] if on a known anticoagulant (e.g. [[heparin]], [[coumadin]], [[rivaroxaban]])		*See [[anticoagulant reversal for life-threatening bleeds]] if on a known anticoagulant (e.g. [[heparin]], [[coumadin]], [[rivaroxaban]])
	*[[Tranexamic acid]] 1g (if within 3 hours of event), followed by an additional 1g infused over 8 hours <ref>[[EBQ:CRASH-3 Trial\|Crash-3 Trial]]</ref>		*[[Tranexamic acid]] 1g (if within 3 hours of event), followed by an additional 1g infused over 8 hours <ref>[[EBQ:CRASH-3 Trial\|Crash-3 Trial]]</ref>

Dieseldoc: /* Elevating head of bed */

2021-10-06T01:24:07Z

Elevating head of bed

← Revisión anterior		Revisión del 01:24 6 oct 2021
Línea 1:		Línea 1:
	===Elevating head of bed===		===Elevating head of bed===
	*30 degree elevation will help decrease ICP<ref>http://stroke.ahajournals.org/content/38/6/2001.full</ref>		*30 degree elevation will help decrease ICP by increasing venous outflow<ref>http://stroke.ahajournals.org/content/38/6/2001.full</ref>

	===[[Seizure]] Prophylaxis and Treatment===		===[[Seizure]] Prophylaxis and Treatment===

Rossdonaldson1: /* Seizure Prophylaxis and Treatment */

2020-06-22T18:26:04Z

Seizure Prophylaxis and Treatment

← Revisión anterior		Revisión del 18:26 22 jun 2020
Línea 5:		Línea 5:
	*Prophylactic antiepileptics '''not''' recommended<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015 </ref>		*Prophylactic antiepileptics '''not''' recommended<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015 </ref>
	*Continuous EEG monitoring probably indicated in ICH patients with depressed mental status that is out of proportion fo degree of brain injury<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015 </ref>		*Continuous EEG monitoring probably indicated in ICH patients with depressed mental status that is out of proportion fo degree of brain injury<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015 </ref>
	*[[Antiepileptics]] indicated for clinical seizures, seizures on EEG in patients with altered mental status<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015 </ref>		*[[Antiepileptics]] indicated for clinical seizures or seizures on EEG in patients with altered mental status<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015 </ref>

	===Blood Pressure===		===Blood Pressure===

Rossdonaldson1: /* Blood Pressure */

2020-06-22T17:57:47Z

Blood Pressure

← Revisión anterior		Revisión del 17:57 22 jun 2020
Línea 8:		Línea 8:

	===Blood Pressure===		===Blood Pressure===
	*Few studies on optimal management however many [[Intracranial hemorrhage (main)\|guidelines recommending moderate reduction]], often a goal systolic of 140-160's
	*Rapid SBP lowering <140 has been advocated with early research showing improved functional outcome<ref>Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013; 368:2355-2365.</ref>, but more recent work has found no difference between SBP <140 and <180<ref>Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016; 1-11. [Epub ahead of print].</ref>		*Rapid SBP lowering <140 has been advocated with early research showing improved functional outcome<ref>Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013; 368:2355-2365.</ref>, but more recent work has found no difference between SBP <140 and <180<ref>Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016; 1-11. [Epub ahead of print].</ref>
	*SBP >200 or MAP >150		*SBP >200 or MAP >150

Rossdonaldson1: /* Antiplatelet Reversal */

2020-06-22T17:56:11Z

Antiplatelet Reversal

← Revisión anterior		Revisión del 17:56 22 jun 2020
Línea 30:		Línea 30:
	*Platelet transfusion		*Platelet transfusion
	**No known thrombocytopenia: ''increases'' mortality; do '''NOT''' give<ref>[[EBQ:Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial\|(PATCH trial)]]</ref>		**No known thrombocytopenia: ''increases'' mortality; do '''NOT''' give<ref>[[EBQ:Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial\|(PATCH trial)]]</ref>
	**Known or diagnosed thrombocytopenia: consider if platelets <50,000,		**Known or diagnosed thrombocytopenia: consider if platelets <50,000
	***Some hematologists and neurosurgeons recommend for <100,000, despite lack of evidence for improved outcomes		***Some hematologists and neurosurgeons recommend for <100,000, despite lack of evidence for improved outcomes

Rossdonaldson1: /* Antiplatelet Reversal */

2020-06-22T17:55:57Z

Antiplatelet Reversal

← Revisión anterior		Revisión del 17:55 22 jun 2020
Línea 28:		Línea 28:
	''Includes [[aspirin]], [[prasugrel]], [[clopidogrel]]''		''Includes [[aspirin]], [[prasugrel]], [[clopidogrel]]''
	*Consider [[desmopressin]] (0.3mcg/kg)		*Consider [[desmopressin]] (0.3mcg/kg)
	*~~Transfusion of platelets has been shown to increase~~ mortality [[EBQ:Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial\|(PATCH trial)]]		*Platelet transfusion
	*In traumatic brain injury, platelet transfusion has been shown to reduce the degree of platelet inhibition, but no change in clinical outcomes<ref>Platelet Transfusion Does Not Improve Outcomes In Patients With Brain Injury On Antiplatelet Therapy Holzmacher, J.L., et al, Brain Injury 32(3):325, 2018</ref>		**No known thrombocytopenia: ''increases'' mortality; do '''NOT''' give<ref>[[EBQ:Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial\|(PATCH trial)]]</ref>
	* ~~Consider platelet transfusion in patients with ICH for platelet count~~ <50,000, ~~but many~~ hematologists and neurosurgeons recommend ~~platelet transfusion~~ for ~~ICH with platelet count~~ < 100,000 despite lack of evidence for improved outcomes~~, especially if the patient requires emergency surgery~~		**Known or diagnosed thrombocytopenia: consider if platelets <50,000,
			***Some hematologists and neurosurgeons recommend for <100,000, despite lack of evidence for improved outcomes

Rossdonaldson1: /* Reverse coagulopathy */

2020-06-22T17:50:14Z

Reverse coagulopathy

← Revisión anterior		Revisión del 17:50 22 jun 2020
Línea 22:		Línea 22:

	===Reverse coagulopathy===		===Reverse coagulopathy===
	*See [[anticoagulant reversal for life-threatening bleeds]] if on a known anticoagulant (e.g. heparin, coumadin, rivaroxaban)		*See [[anticoagulant reversal for life-threatening bleeds]] if on a known anticoagulant (e.g. [[heparin]], [[coumadin]], [[rivaroxaban]])
	*[[Tranexamic acid]] 1g (if within 3 hours of event), followed by an additional 1g infused over 8 hours <ref>[[EBQ:CRASH-3 Trial\|Crash-3 Trial]]</ref>		*[[Tranexamic acid]] 1g (if within 3 hours of event), followed by an additional 1g infused over 8 hours <ref>[[EBQ:CRASH-3 Trial\|Crash-3 Trial]]</ref>

	====Antiplatelet====		====Antiplatelet Reversal====
	*Includes [[aspirin]], [[prasugrel]], [[clopidogrel]]		''Includes [[aspirin]], [[prasugrel]], [[clopidogrel]]''
	*Consider [[desmopressin]] (0.3mcg/kg)		*Consider [[desmopressin]] (0.3mcg/kg)
	*Transfusion of platelets has been shown to increase mortality [[EBQ:Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial\|(PATCH trial)]]		*Transfusion of platelets has been shown to increase mortality [[EBQ:Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial\|(PATCH trial)]]
	*In traumatic brain injury, platelet transfusion has been shown to reduce the degree of platelet inhibition, but no change in clinical outcomes<ref>Platelet Transfusion Does Not Improve Outcomes In Patients With Brain Injury On Antiplatelet Therapy Holzmacher, J.L., et al, Brain Injury 32(3):325, 2018</ref>		*In traumatic brain injury, platelet transfusion has been shown to reduce the degree of platelet inhibition, but no change in clinical outcomes<ref>Platelet Transfusion Does Not Improve Outcomes In Patients With Brain Injury On Antiplatelet Therapy Holzmacher, J.L., et al, Brain Injury 32(3):325, 2018</ref>
	* Consider platelet transfusion in patients with ICH for platelet count <50,000, but many hematologists and neurosurgeons recommend platelet transfusion for ICH with platelet count < 100,000 despite lack of evidence for improved outcomes, especially if the patient requires emergency surgery		* Consider platelet transfusion in patients with ICH for platelet count <50,000, but many hematologists and neurosurgeons recommend platelet transfusion for ICH with platelet count < 100,000 despite lack of evidence for improved outcomes, especially if the patient requires emergency surgery

Rossdonaldson1: /* Seizure Prophylaxis */

2020-06-22T17:48:44Z

Seizure Prophylaxis

← Revisión anterior		Revisión del 17:48 22 jun 2020
Línea 2:		Línea 2:
	*30 degree elevation will help decrease ICP<ref>http://stroke.ahajournals.org/content/38/6/2001.full</ref>		*30 degree elevation will help decrease ICP<ref>http://stroke.ahajournals.org/content/38/6/2001.full</ref>

	===[[Seizure]] Prophylaxis===		===[[Seizure]] Prophylaxis and Treatment===
	*AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015		*Prophylactic antiepileptics '''not''' recommended<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015 </ref>
	**[[Antiepileptics]] indicated for clinical seizures, seizures on EEG in patients with altered mental status		*Continuous EEG monitoring probably indicated in ICH patients with depressed mental status that is out of proportion fo degree of brain injury<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015 </ref>
	**Continuous EEG monitoring probably indicated in ICH patients with depressed mental status that is out of proportion fo degree of brain injury		*[[Antiepileptics]] indicated for clinical seizures, seizures on EEG in patients with altered mental status<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 2015 </ref>
	**Prophylactic antiepileptics '''not''' recommended

	===Blood Pressure===		===Blood Pressure===