Page 12 - ITPS-7-2

INNOSC Theranostics and
Pharmacological Sciences Novel pharmacologic therapies for SAH

release of inflammatory mediators and contributing to controlled trial, and the results demonstrated a significant
complications such as cerebral vasospasm and DCI 36,37 . improvement in patient prognosis, a reduced frequency
SAH leads to cerebral vasospasm, involving the narrowing of hematoma growth, and fewer serious sequelae. These
of cerebral blood vessels due to breakdown products of outcomes corroborate the antifibrinolytic properties of
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blood and inflammation, potentially compromising blood tranexamic acid .
flow to brain tissue. SAH primarily stems from ruptured
intracranial aneurysms , as emphasized in Kellner 3.1.3. Antioxidants
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et al. . This rupture leads to an immediate disruption One promising medication for the treatment of ICH is
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in hemodynamics, causing increased ICP and reduced edaravone. While it has demonstrated efficacy in patients
cerebral blood flow, amplifying the impact of SAH. In with ICH, the debate about its long-term advantages and
addition, inflammatory responses, as highlighted in prognosis persists . This potent free radical scavenger 46-50
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Cardentey-Pereda and Pérez-Falero , are initiated as was initially licensed in Japan 51,52 for the management of
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blood enters the subarachnoid space, contributing to acute ischemic stroke (AIS).
complications such as cerebral vasospasm. This narrowing 3.2. Surgical management
of cerebral blood vessels can further compromise blood
flow to the brain. In summary, the pathophysiology of 3.2.1. Craniopuncture
SAH involves vascular rupture, hemodynamic disruption, Craniopuncture has been the accepted method of
and inflammatory processes, collectively contributing to treating ICH in China . In a study comparing the results
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its complex clinical manifestations. of craniopuncture and conservative management in
377 patients who experienced basal ganglia hemorrhage,
3. Current treatment options researchers discovered that patients undergoing
The two basic categories of treatment for SAH are craniopuncture exhibited significantly improved
surgical and pharmacologic. Non-contrast computerized neurological function by the end of 2 weeks, with no
tomography (NCCT) is a quick, reliable, and accurate variation in the rates of rebleeding and no discernible
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method for identifying SAH . Following an acute difference in patient mortality .
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episode, a significant proportion of patients with SAH and 3.2.2. Craniotomy
intracerebral hemorrhage (ICH) showed a two-point decline
on the Glasgow Coma Scale 42,43 . The primary goals of care While the role of surgery in treating patients with ICH
for unstable patients are to secure the airway and continue remains a subject of debate, craniotomy for hematoma
resuscitative procedures before arriving at the hospital. drainage is the most commonly utilized method in
hospitals 55,56 . The surgical study in ICH (STICH) aimed to
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3.1. Pharmacologic management assess the benefits of prompt hematoma drainage combined
3.1.1. Blood pressure control with conservative treatment in a multifocal, multinational,
randomized clinical study. The study concluded that
During the acute phase, the majority of ICH patients prompt hematoma drainage did not improve the overall
present with high blood pressure when they first arrive. prognosis . However, when significant hematomas impart
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This high blood pressure might lead to hematoma a mass effect with midline shift causing altered awareness,
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development and a dismal prognosis . The INTERACT2 or when the neurological decline occurs due to hematoma
trial, a major clinical trial that randomly assigned patients enlargement, a craniotomy becomes an essential life-
to either a blood pressure control group with systolic blood saving procedure.
pressure <140 mmHg or a blood pressure control group of
systolic blood pressure <180 mmHg for the first 24 h, has 3.2.3. Hematoma aspiration and thrombolysis
provided the most comprehensive data on blood pressure After a minimum of 5 – 6 h following the computed
management. tomography scan used for diagnosis in stereotactic
3.1.2. Use of tranexamic acid and factor VII aspiration with thrombolysis, patients undergo a follow-up
scan to assess the stable nature of the clot. In the Minimally
Tranexamic acid is used to reduce bleeding-related Invasive Surgery Plus Alteplase for ICH Evacuation
mortality in trauma and postpartum hemorrhage (MISTIE) trials, stereotactic hematoma aspiration with
situations. An investigation into the potential of tranexamic thrombolysis and medical therapy were compared in
acid to reduce hematoma growth and enhance prognosis three stages. The initial published results indicate that the
in adult ICH-related stroke patients was carried out. MISTIE approach resulted in a greater reduction in clot
Adult participants with ICH took part in a randomized volume compared to medical treatment .
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Volume 7 Issue 2 (2024) 6 doi: 10.36922/itps.2019