Preserving brain health after intracerebral haemorrhage

Intracerebral haemorrhage is the most severe type of stroke, associated with the highest mortality and with substantial disability among survivors. Paradoxically, for patients who survive, intracerebral haemorrhage can provide an opportunity to take steps to prevent progressive deterioration in brain health over time. Most intracerebral haemorrhage events occur as the acute manifestation of common forms of progressive cerebral small vessel diseases. 1 Hostettler IC Seiffge DJ Werring DJ Intracerebral hemorrhage: an update on diagnosis and treatment. Expert Rev Neurother. 2019; 19: 679-694 Crossref PubMed Scopus (86) Google Scholar Because of the relentless progression of these diseases, as many as half of survivors will have a recurrent stroke (either haemorrhagic or ischaemic), incident cognitive decline, or incident depression in the 5 years after their intracerebral haemorrhage. 2 Casolla B Moulin S Kyheng M et al. Five-year risk of major ischemic and hemorrhagic events after intracerebral hemorrhage. Stroke. 2019; 50: 1100-1107 Crossref PubMed Scopus (48) Google Scholar , 3 Pasi M Sugita L Xiong L et al. Association of cerebral small vessel disease and cognitive decline after intracerebral hemorrhage. Neurology. 2021; 96: e182-e192 Crossref PubMed Scopus (18) Google Scholar Control of blood pressure is the most effective way known to slow or possibly arrest this progression. 4 The Lancet NeurologyA social dimension for brain health: the mounting pressure. Lancet Neurol. 2021; 20: 773 Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar Apixaban versus no anticoagulation after anticoagulation-associated intracerebral haemorrhage in patients with atrial fibrillation in the Netherlands (APACHE-AF): a randomised, open-label, phase 2 trialPatients with atrial fibrillation who had an intracerebral haemorrhage while taking anticoagulants have a high subsequent annual risk of non-fatal stroke or vascular death, whether allocated to apixaban or to avoid anticoagulation. Our data underline the need for randomised controlled trials large enough to allow identification of subgroups in whom restarting anticoagulation might be either beneficial or hazardous. Full-Text PDF