Recombinant activated factor VII for acute intracerebral hemorrhage

Acute stroke is the third leading cause of death worldwide, exceeded only by coronary artery disease and cancer. There are two major subtypes of strokeischemic and hemorrhagic with 20-30% of all strokes being hemorrhagic in nature. The incidence of ischemic strokes has steadily declined by virtue of rigorous risk factor modification, but the same has not been possible for hemorrhagic strokes. Moreover, ischemic strokes can now be effectively treated by thrombolysis with tissue plasminogen activator. On the other hand, the incidence of intracerebral hemorrhage (ICH) is expected to grow, given the aging of the population. The treatment of hemorrhagic strokes remains mainly conservative with a recent large multi-centric study failing to show any benefit from early surgery and the mortality at 30 days is seven times higher than ischemic strokes (63% vs. 9%). However, it is believed that strict control of hypertension may significantly decrease the incidence of nonlobar type of ICH.[4] The above factors clearly point towards the need for newer drugs or treatment modalities for patients with ICH. Recombinant activated factor VII (rFVIIa), as shown in some recent trials, appears to be of promise in the management of ICH.