Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 55, Num. 1, 2007, pp. 81-81

Neurology India, Vol. 55, No. 1, January-March, 2007, pp. 81

Letter To Editor

Expansion of traumatic intracerebral hemorrhage: Treatment implications with recombinant factor VIIa

Kumar Sudhir

Apollo Hospitals, Jubilee Hills, Hyderabad - 500 033, Andhra Pradesh
Correspondence Address:Apollo Hospitals, Jubilee Hills, Hyderabad - 500 033, Andhra Pradesh, drsudhirkumar@yahoo.com

Date of Acceptance: 15-Nov-2006

Code Number: ni07025

Sir,

I read with interest the recent article by Yadav et al .[1] They reported an expansion in hematoma volume in about 16% of cases that were re-imaged within 24 hours of the initial CT scan. Presence of coagulopathy was an important predictor of hematoma expansion.

This finding could allow the use of newer therapeutic options for traumatic intracerebral hemorrhage (ICH). Hematoma expansion is known to occur in 38% of spontaneous ICH.[2] Treatment with recombinant factor VIIa (rFVIIa) within 4 hours of symptom onset was found to be efficacious and safe in spontaneous ICH.[3] As hematoma volume and the presence of coagulopathy are important determinants of outcome in traumatic ICH,[4] therapies aimed at limiting the hematoma size and correcting the coagulopathy would be beneficial in them. In a recent case report, two patients with worsening hemorrhage on the CT scan were treated with a single dose of rFVIIa (120 mcg/Kg).[5] CT findings and coagulation parameters improved after treatment with rFVIIa in both the patients. Prospective, randomized, multicentric trials are planned to further elucidate this hypothesis.

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