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Hematoma enlargement (HE) is a determinant of the adverse consequences of acute intracerebral hemorrhage (ICH), and it is also a compelling target of clinical trials
.
Although hemodynamic and hemostatic therapies seem to reduce hematomas, it is challenging to prove their efficacy in phase III trials
The current HE evaluation as a result of a biomarker includes a comparison of central trends (median and mean) and an analysis of a fixed dichotomy threshold
thrombus
In this way, Vignan Yogendrakumar and others of the University of Ottawa, a more detailed assessment of the distribution of changes in hematoma volume may better assess the biological effects of the relevant treatment, and may support a re-examination of the previous "neutral" treatment plan in order to Further research
.
They proposed a "hematoma metastasis" analysis model as a strategy for ICH treatment evaluation, and used previously published clinical trial data to illustrate this method
They used the data from the antihypertensive treatment of acute cerebral hemorrhage II (ATACH-2) trial to conduct an HE transition analysis on the response to enhanced blood pressure, according to
a) the previously established definition of HE,
b) the percentile of hematoma volume change/ Absolute quartile,
c) The quartile of hematoma volume in the 24-hour follow-up, resulting in a multi-quantile layer
.
The cox model was used to explore the relationship between blood pressure treatment and hematoma conversion
The main analysis population includes 863 patients
.
They found that about one-third of the patients in the two treatment groups did not develop hematomas
Using the three-point method of HE stratification, the highest stratification of ≥33% showed that the increase of hematoma in randomized patients receiving intensive treatment was reduced by 5.
8% (aOR: 0.
77 [95% CI: 0.
60-0.
99])
Using the percentile quartile of the change in hematoma volume, in patients receiving intensive treatment, the beneficial change in reducing hematoma growth: aOR: 0.
73 (0.
57-0.
The important significance of this study is that it has been found that intensive blood pressure reduction can give priority to alleviating the growth of patients at risk of hypervolemic hematoma
.
The shift analysis model of hypertension provides additional explanations for the biological effects of specific treatments and may be an additional way to evaluate hemostatic agents in future studies
It was found that intensive blood pressure reduction can give priority to alleviating the growth of patients at risk of high-volume hematoma
.
The shift analysis model of hypertension provides additional explanations for the biological effects of specific treatments and may be an additional way to evaluate hemostatic agents in future studies
.
It was found that intensive blood pressure reduction can give priority to alleviating the growth of patients at risk of hypervolemic hematoma
.
The shift analysis model of hypertension provides additional explanations for the biological effects of specific treatments and may be an additional way to evaluate hemostatic agents in future studies
.
Original source:
Yogendrakumar V, Ramsay T, Menon BK, Qureshi AI, Saver JL, Dowlatshahi D.
Hematoma Expansion Shift Analysis to Assess Acute Intracerebral Hemorrhage Treatments.
Neurology.
2021 Jun 18:10.
1212/WNL.
0000000000012393.
doi: 10.
1212/WNL.
0000000000012393.
Epub ahead of print.
PMID: 34144995.