Prothrombotic recombinant activated factor VII in intracerebral haemorrhage: FAST but not focused?

摘要

Over a decade ago, a major change occurred in the treatment of ischaemic stroke, with the publication of the pivotal trial of recombinant tissue plasminogen activator (rtPA). Despite an increase in symptomatic intracerebral bleeding in those treated with rtPA versus placebo (6.4% vs 0.6%; p<0001) and no difference in mortality, this new treatment yielded a net improvement of good functional outcome of 30%. Ten years later, we were encouraged by preliminary results in the less common but more feared stroke subtype-intracerebral haemorrhage (ICH).Mayerandcolleagues2 showed that treatment with recombinant activated factor VII (rFVIIa) versus placebo within 4 hours of stroke onset limited the growth of ICH (relative reduction 52%; p=0.01), reduced mortality (relative reduction 38%; p=002), and decreased the proportion of severe disability and death (absolute reduction 16%; p=0004), but at the expense of increased numbers of thromboembolic complications (absolute increase 5%; p=012).