Not much works to treat ICH – and this retrospective analysis of INTERACT1 tries to coordinate a couple leaps to pull a different spin out of old data. Unfortunately, it’s still a re-analysis of essentially a negative trial, and that limits its utility for the purists.
INTERACT1 randomized patients with ICH to either “intensive” blood pressure lowering or conventional treatment – most of whom received some BP control – and noted significant improvements in hematoma volume. However, the 90-day safety/clinical outcomes data did not show any difference in mortality or dependency. This publication reverses the strategy, taking a look at the associations between good clinical outcomes and hematoma volume – and finds that increases in hematoma volume at 24 hours clearly predict poor clinical outcomes.
So, if intensive BP control reduces hematoma expansion and reduced hematoma expansion improves clinical outcomes, then why was INTERACT1 negative? I suspect we’ll find out more when INTERACT2 is published….
“Hematoma growth and outcomes in intracerebral hemorrhage: The INTERACT1 study”