TY - JOUR T1 - Treating supratentorial intracerebral haemorrhage: hopeless? Or rethink our strategy JF - Stroke and Vascular Neurology JO - Stroke Vasc Neurol SP - 158 LP - 159 DO - 10.1136/svn-2021-001043 VL - 6 IS - 2 AU - David Z Wang AU - Liping Liu AU - Guohua Xi AU - Yongjun Wang Y1 - 2021/06/01 UR - http://svn.bmj.com/content/6/2/158.abstract N2 - Intracerebral haemorrhage (ICH) is the deadliest (40%) among all strokes.1 There are about 2 million ICHs annually worldwide, but effective treatment is still lacking. An ICH volume of <30 cm3 may have a 30-day mortality of 19%.2 Clinical research on treating ICH has been focusing on blood pressure control, haemostatic therapy, surgical evacuation of the clot and effective drainage of intraventricular blood. The principles behind these therapies include stopping the haemorrhage, preventing haematoma expansion, reducing the clot burden, reducing intracranial pressure and preventing obstructive hydrocephalus. However, the outcome of these trials has not been ideal. Only tight blood pressure control and posterior fossa haematoma evacuation have been incorporated into the standard clinical practice.Recently, Stroke and Vascular Neurology published two articles online on the aspect of using haemostatic therapy for ICH. The Tranexamic acid for acute intracerebral hemorrhage growth based on imaging assessment (TRAIGE) trial studied the effect of tranexamic acid on reducing the risk of haematoma expansion in patients with ICH with either the black hole, blend or spot sign on noncontrast CT or CT angiography.3 These three radiological findings in patients with ICH are indicative of higher risk of haematoma expansion. After randomising 171 patients to tranexamic acid or placebo within 8 hours of onset, the intent … ER -