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European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage

Steiner, Thorsten; Al-Shahi Salman, Rustam; Beer, Ronnie; Christensen, Hanne; Cordonnier, Charlotte; Csiba, Laszlo; Forsting, Michael; Harnof, Sagi; Klijn, Catharina J. M. and Krieger, Derk, et al. (2014) In International Journal of Stroke 9(7). p.840-855
Abstract
BackgroundIntracerebral hemorrhage (ICH) accounted for 9% to 27% of all strokes worldwide in the last decade, with high early case fatality and poor functional outcome. In view of recent randomized controlled trials (RCTs) of the management of ICH, the European Stroke Organisation (ESO) has updated its evidence-based guidelines for the management of ICH. MethodA multidisciplinary writing committee of 24 researchers from 11 European countries identified 20 questions relating to ICH management and created recommendations based on the evidence in RCTs using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. ResultsWe found moderate- to high-quality evidence to support strong recommendations for managing... (More)
BackgroundIntracerebral hemorrhage (ICH) accounted for 9% to 27% of all strokes worldwide in the last decade, with high early case fatality and poor functional outcome. In view of recent randomized controlled trials (RCTs) of the management of ICH, the European Stroke Organisation (ESO) has updated its evidence-based guidelines for the management of ICH. MethodA multidisciplinary writing committee of 24 researchers from 11 European countries identified 20 questions relating to ICH management and created recommendations based on the evidence in RCTs using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. ResultsWe found moderate- to high-quality evidence to support strong recommendations for managing patients with acute ICH on an acute stroke unit, avoiding hemostatic therapy for acute ICH not associated with antithrombotic drug use, avoiding graduated compression stockings, using intermittent pneumatic compression in immobile patients, and using blood pressure lowering for secondary prevention. We found moderate-quality evidence to support weak recommendations for intensive lowering of systolic blood pressure to <140mmHg within six-hours of ICH onset, early surgery for patients with a Glasgow Coma Scale score 9-12, and avoidance of corticosteroids. ConclusionThese guidelines inform the management of ICH based on evidence for the effects of treatments in RCTs. Outcome after ICH remains poor, prioritizing further RCTs of interventions to improve outcome. (Less)
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published
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keywords
anticoagulation, antiepileptic treatment, antihypertensive treatment, intracranial hemorrhage, intracranial pressure, management
in
International Journal of Stroke
volume
9
issue
7
pages
840 - 855
publisher
Wiley-Blackwell
external identifiers
  • wos:000342581900010
  • scopus:84907876500
ISSN
1747-4949
DOI
10.1111/ijs.12309
language
English
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yes
id
c987fdba-d8e4-4a12-a185-d5cdd52dd08e (old id 4803445)
date added to LUP
2014-12-01 07:34:01
date last changed
2017-11-05 03:16:30
@article{c987fdba-d8e4-4a12-a185-d5cdd52dd08e,
  abstract     = {BackgroundIntracerebral hemorrhage (ICH) accounted for 9% to 27% of all strokes worldwide in the last decade, with high early case fatality and poor functional outcome. In view of recent randomized controlled trials (RCTs) of the management of ICH, the European Stroke Organisation (ESO) has updated its evidence-based guidelines for the management of ICH. MethodA multidisciplinary writing committee of 24 researchers from 11 European countries identified 20 questions relating to ICH management and created recommendations based on the evidence in RCTs using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. ResultsWe found moderate- to high-quality evidence to support strong recommendations for managing patients with acute ICH on an acute stroke unit, avoiding hemostatic therapy for acute ICH not associated with antithrombotic drug use, avoiding graduated compression stockings, using intermittent pneumatic compression in immobile patients, and using blood pressure lowering for secondary prevention. We found moderate-quality evidence to support weak recommendations for intensive lowering of systolic blood pressure to &lt;140mmHg within six-hours of ICH onset, early surgery for patients with a Glasgow Coma Scale score 9-12, and avoidance of corticosteroids. ConclusionThese guidelines inform the management of ICH based on evidence for the effects of treatments in RCTs. Outcome after ICH remains poor, prioritizing further RCTs of interventions to improve outcome.},
  author       = {Steiner, Thorsten and Al-Shahi Salman, Rustam and Beer, Ronnie and Christensen, Hanne and Cordonnier, Charlotte and Csiba, Laszlo and Forsting, Michael and Harnof, Sagi and Klijn, Catharina J. M. and Krieger, Derk and Mendelow, A. David and Molina, Carlos and Montaner, Joan and Overgaard, Karsten and Petersson, Jesper and Roine, Risto O. and Schmutzhard, Erich and Schwerdtfeger, Karsten and Stapf, Christian and Tatlisumak, Turgut and Thomas, Brenda M. and Toni, Danilo and Unterberg, Andreas and Wagner, Markus},
  issn         = {1747-4949},
  keyword      = {anticoagulation,antiepileptic treatment,antihypertensive treatment,intracranial hemorrhage,intracranial pressure,management},
  language     = {eng},
  number       = {7},
  pages        = {840--855},
  publisher    = {Wiley-Blackwell},
  series       = {International Journal of Stroke},
  title        = {European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage},
  url          = {http://dx.doi.org/10.1111/ijs.12309},
  volume       = {9},
  year         = {2014},
}