When and how is possible hemostatic therapy in non anticoagulant-associated intracerebral haemorrhage

Hematoma volume is a major determinant of outcome in spontaneous intracerebral haemorrhage (ICH) and its secondary expansion occurs frequently and early with the potential sequelae of rostrocaudal deterioration or death. Therefore, early restriction of ICH volume is of paramount importance. Although few indications appear to be available for neurosurgical measures, nonsurgical measures such as reduction of hypertension and normalisation of altered coagulation seem to be beneficial. However, the routinary use of coagulation factors outside of anticoagulant-associated spontaneous ICH cannot generally be recommended at present. Future trials on recombinant coagulation factor VIIa with stricter selection criteria of inclusion time window, ICH and intraventricular haemorrhage volume, and age of patients are needed.