{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:06:46Z","timestamp":1777943206981,"version":"3.51.4"},"reference-count":58,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T00:00:00Z","timestamp":1602720000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>Intracerebral hemorrhage (ICH) represents a major, global, unmet health need with few treatments. A significant minority of ICH patients present taking an anticoagulant; both vitamin-K antagonists and increasingly direct oral anticoagulants. Anticoagulants are associated with an increased risk of hematoma expansion, and rapid reversal reduces this risk and may improve outcome. Vitamin-K antagonists are reversed with prothrombin complex concentrate, dabigatran with idarucizumab, and anti-Xa agents with PCC or andexanet alfa, where available. Blood pressure lowering may reduce hematoma growth and improve clinical outcomes and careful (avoiding reductions\u2009\u226560\u2009mm Hg within 1 h), targeted (as low as 120\u2013130\u2009mm Hg), and sustained (minimizing variability) treatment during the first 24\u2009h may be optimal for achieving better functional outcomes in mild-to-moderate severity acute ICH. Surgery for ICH may include hematoma evacuation and external ventricular drainage to treat hydrocephalus. No large, well-conducted phase III trial of surgery in ICH has so far shown overall benefit, but meta-analyses report an increased likelihood of good functional outcome and lower risk of death with surgery, compared to medical treatment only. Expert supportive care on a stroke unit or critical care unit improves outcomes. Early prognostication is difficult, and early do-not-resuscitate orders or withdrawal of active care should be used judiciously in the first 24\u201348\u2009h of care. Implementation of acute ICH care can be challenging, and using a care bundle approach, with regular monitoring of data and improvement of care processes can ensure consistent and optimal care for all patients.<\/jats:p>","DOI":"10.1177\/1747493020964663","type":"journal-article","created":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T02:47:22Z","timestamp":1602816442000},"page":"945-953","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":29,"title":["Treatment of intracerebral hemorrhage: From specific interventions to bundles of care"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4462-3846","authenticated-orcid":false,"given":"Adrian R","family":"Parry-Jones","sequence":"first","affiliation":[{"name":"Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK"},{"name":"Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6786-3623","authenticated-orcid":false,"given":"Tom J","family":"Moullaali","sequence":"additional","affiliation":[{"name":"Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, UK"},{"name":"George Institute for Global Health, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy C","family":"Ziai","sequence":"additional","affiliation":[{"name":"Division of Neurosciences Critical Care, Department of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,10,15]]},"reference":[{"key":"bibr1-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1159\/000506396"},{"key":"bibr2-1747493020964663","unstructured":"Global, regional, and national burden of stroke, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016.\n                      Lancet Neurol\n                      2019; 18: 439\u2013458."},{"key":"bibr3-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30506-2"},{"key":"bibr4-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aws349"},{"key":"bibr5-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25546"},{"key":"bibr6-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09536-1"},{"key":"bibr7-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25342"},{"key":"bibr8-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(16)00110-1"},{"key":"bibr9-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.0846"},{"key":"bibr10-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1136\/bmjquality.u208763.w3521"},{"key":"bibr11-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2019-000883"},{"key":"bibr12-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1502000"},{"key":"bibr13-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000069"},{"key":"bibr14-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1177\/2396987319849763"},{"key":"bibr15-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.013445"},{"key":"bibr16-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-05-782060"},{"key":"bibr17-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1636541"},{"key":"bibr18-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814051"},{"key":"bibr19-1747493020964663","unstructured":"Demchuk AM, Zotova E, Nakamya J, et\u00a0al. Hemstatic efficacy and anti-FXa reversal with andexanet alfa in spontaneous intracerebral hemorrhage.\n                      Milan: Eur Stroke J\n                      2019; 3\u201395."},{"key":"bibr20-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13193"},{"key":"bibr21-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30392-0"},{"key":"bibr22-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31033-X"},{"key":"bibr23-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707534"},{"key":"bibr24-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000002056"},{"key":"bibr25-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(14)70018-3"},{"key":"bibr26-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-008-9085-8"},{"key":"bibr27-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(08)70069-3"},{"key":"bibr28-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214609"},{"key":"bibr29-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.000188"},{"key":"bibr30-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603460"},{"key":"bibr31-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12309"},{"key":"bibr32-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1159\/000462986"},{"key":"bibr33-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2016-315346"},{"key":"bibr34-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(19)30196-6"},{"key":"bibr35-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25793"},{"key":"bibr36-1747493020964663","doi-asserted-by":"crossref","unstructured":"RIGHT-2 Investigators. Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial.\n                      Lancet\n                      2019; 393: 1009\u20131020.","DOI":"10.1016\/S0140-6736(19)30194-1"},{"key":"bibr37-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.026389"},{"key":"bibr38-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-030121"},{"key":"bibr39-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)70233-6"},{"key":"bibr40-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60986-1"},{"key":"bibr41-1747493020964663","volume":"382","author":"Hanley DF","year":"2013","journal-title":"Lancet"},{"key":"bibr42-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyz077"},{"key":"bibr43-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25732"},{"key":"bibr44-1747493020964663","unstructured":"Luzzi S, Elia A, Del Maestro M, et\u00a0al. Indication, timing, and surgical treatment of spontaneous intracerebral hemorrhage: systematic review and proposal of a management algorithm.\n                      World Neurosurg\n                      2019; S1878-8750(19): 30105\u20136."},{"key":"bibr45-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.020688"},{"key":"bibr46-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.10.167"},{"key":"bibr47-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.13014"},{"key":"bibr48-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000304930.47751.75"},{"key":"bibr49-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1007\/3-211-30714-1_16"},{"key":"bibr50-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32410-2"},{"key":"bibr51-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000125858.71051.ca"},{"key":"bibr52-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181ed9cc9"},{"key":"bibr53-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001525"},{"key":"bibr54-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-018-0633-6"},{"key":"bibr55-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002266"},{"key":"bibr56-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000197.pub4"},{"key":"bibr57-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200103000-00031"},{"key":"bibr58-1747493020964663","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-50"}],"container-title":["International Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1747493020964663","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1747493020964663","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1747493020964663","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T07:19:13Z","timestamp":1777706353000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1747493020964663"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,15]]},"references-count":58,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1177\/1747493020964663"],"URL":"https:\/\/doi.org\/10.1177\/1747493020964663","relation":{},"ISSN":["1747-4930","1747-4949"],"issn-type":[{"value":"1747-4930","type":"print"},{"value":"1747-4949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,15]]}}}