Hämostatische Therapie der intrazerebralen Blutung

Zusammenfassung

In den letzten Jahren rückte die spontane intrazerebrale Blutung (ICB) mehr und mehr in das Interesse der Schlaganfallforschung und ist dabei, neben der zerebralen Ischämie, einen zweiten Schwerpunkt klinischer Studien zu bilden. Entscheidend hierfür waren unter anderem zwei multizentrische, randomisierte, kontrollierte Therapiestudien, die Anfang 2005 veröffentlicht wurden: Die International Surgical Trial in Intracerebral Haemorrhage (STICH) und die Studie über den rekombinanten aktivierten Faktor VII. Beide beruhen auf der pathophysiologischen Überlegung einer Verbesserung des klinischen Verlaufs durch Verkleinerung des intrazerebralen Hämatoms, entweder durch chirurgische Entfernung oder durch medikamentöse Verminderung des Hämatomwachstums. Wir fassen die wesentlichen ätiologischen und pathophysiologischen Hintergründe der hämostatischen Therapie der ICB zusammen und gehen kurz auf die Antikoagulantien (OAT)-assoziierte ICB ein. Zum Schluss diskutieren wir die Konsequenzen für die zukünftige Therapie und für weitere klinische Studien.

Summary

In recent years, spontaneous intracerebral haemorrhage (ICH) gains more and more interest within stroke research and becomes a major focus of clinical studies. Among others, two multi-centre, randomized, controlled trials were crucial for this development. Both have been published early in 2005: The International Surgical Trial in Intracerebral Haemorrhage (STICH), and the trial investigating recombinant activated factor VII. Both studies are based on the pathophysiological concept of improving the clinical course by reducing the size of the intracerebral haematoma, either by surgical removal or by pharmacological reduction of haematoma growth. We summarize the most important etiologic and pathophysiologic background of haemostatic treatment of ICH and shortly mention oral anticoagulation treatment (OAT)-related ICH. Finally, we discuss the consequences for future therapy and clinical trials.

Schlüsselwörter

Intrazerebrale Blutung - Therapie - klinische Studien

Keywords

Intracerebral haemorrhage - therapy - clinical trials

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