The Clinical Evaluation And Antiapoptotic Effect Study Of Recombinant Activated Factor â…¦ For Acute Intracerebral Hemorrhage

Backround and Object:Many studys indicated hematoma growth occured in 38% of ICH patients scanned within 3 hours of onset, hematoma growth can result in sharply dilatability disruption of adjacent tissue in acute cerebral hemorrhage ,which can contribute to midline shift and accelerates neurological deterioration, hematoma growth is independly predict factor of both mortality and good outcome with the hemorrhage patient. Thereby , the control of hematoma growth is a key point of the cerebral hemorrhage treatment . Intervention with so-called ultra-early hemostatic therapy in the emergency department might improve outcomes after intracerebral hemorrhage by arresting ongoing bleeding and minimizing increasesin the volume of the hematoma. rFVIIa may be well suited forlimiting early hematoma growth in acute ICH. rFVIIa is an important natural initiator of hemostasis and exerts its primary effects locally in regions of endothelial disruption andvascular injury.Our study observed whether rFVIIa can reduce hematoma growth after intracerebral hemorrhage and improves functional outcomes at 90 days. Methods:We choose the spontaneous intracerebral hemorrhage patient who is eligible for enrollment .We randomly assigned the patients to receive controled or 40 μ g of rFVIIa per kilogram of body weight, 80 μ g per kilogram within one hour after the baseline scan. Follow-up CT scanning was performed at 24 and 72 hours after study treatment.Consequently we observed the change of hematoma volume and brain edema in the two rFVIIa-treatment groups as compared with the controled group. Clinical assessments were performed at various time with the use of GCS NIHSS, mRs BI, the outcome is compared between the two rFVIIa-treatment groups and the controled group. Result: 1 The absolute increase hematoma volume of rFVIIa-treatment group is lessthan controled group at 24 hours after study treatment(3.0mlVS8.4ml);2, The total lesion volume at 72 hours was reduced by an estimated mean of9.2ml with rFVIIa treatment, as compared with controled group;3^ The modified ICH Scale score at 24 hours after treatment is more than thescore of at baseline time. The score of rFVIIa-treatment group is less thancontroled group at 24 hours after treatment, which can predict the betteroutcome than the controled group. 4^ The total outcome is compared between rFVIIa-treatment group and controledgroup at 15d and 90d after treatment. The unfavorable outcome proportionof the rFVIIa-treatment group is lower than controled group at 15d and 90d.The total outcome of rFVIIa-treatment group is better than controled group at15d and 90d,which is matched with the the modified ICH Scale score of twogroup at 24 hours after treatment. Conclusions: 1> Treatment with rFVIIa within 3 hours after the onset of intracerebralhemorrhage limits the growth of the hematoma and reduce the total lesionvolume. 2^ The clinical effect is nearly between 80ug /kg rFVIIa group and 40ug /kgrFVIIa group;3- The modified ICH Scale score at 24 hours after treatment is more accuratethan at basline time, and is reliable to predict mortality and good outcome. 4> The total outcome of rFVIIa-treatment group is better than controledgroup .Treatment with rFVIIa can reduce the unfavorable outcome proportionof cerebral hemorrhage...