Key recommendations for ICH management
| Recommendation | Quality of evidence* | Strength of recommendation† |
|---|---|---|
| Admit to a designated stroke unit for initial active management | High | Strong |
| Use cerebrovascular imaging to exclude a vascular anomaly | Moderate‡ | Strong |
| Intensively control BP (systolic target <140 mm Hg within 1 hour of presentation) as it is safe and improves functional recovery | Moderate | Moderate |
| Provide feeding (enteral if necessary) within 48 hours of onset | Low | Weak |
| Control elevated glucose | Low | Weak |
| Rapidly treatment fever | Low | Weak |
| Control seizures with an antiepileptic drug | Moderate | Moderate |
| Avoid prophylactic use of antiepileptic drugs | Low | Weak |
| In immobile patients, avoid graduated compression stockings and use intermittent pneumatic compression to reduce DVT risk | High | Strong |
| If there is elevated ICP, use simple measures (eg, head elevation, analgesia, antiemetics) and assisted ventilation when severe | Low | Weak |
| Avoid activated recombinant factor VII | Moderate | Strong |
| Avoid platelet transfusion in antithrombotic related ICH | Moderate | Moderate |
| Rapidly reverse anticoagulation with intravenous vitamin K and PCC in vitamin K-associated ICH | Moderate | Moderate |
| Rapidly reverse anticoagulation with PCC and/or selective antidotes in DOAC-associated ICH | Low | Weak |
| Reduce risk of recurrent ICH and other serious vascular events through strict long-term control of BP (systolic target <140 mm Hg) | Moderate | Strong |
| Resume antithrombotic drugs after ICH | Low | Weak |
*Grading of evidence:93 high—consistent data from multiple randomised controlled trials; moderate—insufficient data from single large or multiple small randomised trials; weak—data derived mainly observational studies.
†Grading of recommendation:93 strong—there are clear benefits; moderate—there are probable benefits that out way potential harms; weak—there is uncertainty over the balance of benefits and harms.
‡Based on data from good-quality observational studies.
BP, blood pressure; DOAC, direct oral anticoagulant; DVT, deep venous thrombosis; ICH, intracerebral haemorrhage; ICP, intracranial pressure; iv, intravenous; PCC, prothrombin concentrate complex.