New bleeding stroke guidelines highlight several common treatments that may be ineffective

Certain strategies for treating or preventing intracerebral hemorrhages (ICHs), also known as bleeding strokes, may not be as effective as physicians previously believed, according to a new guidance document from the American Heart Association (AHA) and American Stroke Association (ASA).

The new guideline, developed by a volunteer writing group on behalf of the AHA and ASA, was published in Stroke.[1] It represents an update from previous AHA/ASA guidelines on ICH management published in 2015.

Topics covered in the analysis range from surgical techniques and patient recovery time to recommended training for at-home caregivers.

“Advances have been made in an array of fields related to ICH, including the organization of regional health care systems, reversal of the negative effects of blood thinners, minimally invasive surgical procedures and the underlying disease in small blood vessels,” Steve Greenberg, MD, PhD, a professor of neurology at Harvard Medical School, vice chair of neurology at Massachusetts General Hospital, said in a prepared statement. Greenberg served as the volunteer writing group’s chair.

Key takeaways from the American Heart Association and American Stroke Association’s updated intracerebral hemorrhage guidelines

Wearing compression socks or stockings is not an effective way to prevent deep vein thrombosis after an ICH, according to the new document. This has long been a common recommendation made by physicians and other healthcare providers. Intermittent pneumatic compression with inflatable boots is now seen as a preventive action that may make a bigger impact on patient care.

“This is an area where we still have a lot of exploration to do,” Greenberg said in the prepared statement. “It is unclear whether even specialized compression devices reduce the risks of deep vein thrombosis or improve the overall health of people with a brain bleed. Even more research is needed on how new blood clot prevention medications may help, especially within the first 24 to 48 hours of the first symptoms.”

The use of anti-seizure medications or antidepressants after an ICH is also addressed in the guidelines. Clinical studies have found that both treatment options fail to help ICH patients as some clinicians previously believed. Administering steroids while ICH patients are still hospitalized was also listed as a common treatment option that should be avoided in the future.

The document also highlighted the recent finding that certain minimally invasive surgeries may increase a patient’s risk of survival following a moderate or large ICH. In addition, it is recommended that patients recovering from a mild or moderate ICH start basic activities such as stretching, dressing or bathing within one or two days following the ICH to improve their chance of survival. Too much activity, however, especially in the first 24 hours, has been linked to a higher risk of death within 14 days.