Abstract
This article presents a translated summary of the 2022 American Heart Association/American Stroke Association (AHA/ASA) guideline on managing patients with spontaneous intracerebral hemorrhage (ICH), aiming to update clinical knowledge for Vietnamese practitioners. For diagnosis, the guideline emphasizes baseline laboratory testing, urgent CT/MRI to confirm hemorrhage, and serial CT within the first 24 hours to monitor hematoma expansion. Vascular imaging (CTA, CTV, MRA, DSA) is recommended based on age, hemorrhage location, and hypertension history to exclude underlying vascular causes. Regarding acute management, recommendations include early blood pressure lowering with a target systolic pressure of 130–150 mmHg for mild-to-moderate hemorrhage, rapid reversal of anticoagulation (using PCC, andexanet alfa, idarucizumab, or protamine depending on the agent), and multidisciplinary inpatient care in stroke units or neurocritical care. Additional topics covered include venous thromboembolism prophylaxis, glucose and temperature management, seizure management, intracranial pressure monitoring, and surgical indications (minimally invasive hematoma evacuation, external ventricular drainage, decompressive craniectomy) based on hematoma location and volume. On prognosis and recovery, the guideline highlights early multidisciplinary rehabilitation, screening for post-stroke depression, anxiety, and cognitive impairment, and cautions against premature withdrawal of life-sustaining care. For secondary prevention, strict blood pressure control (<130/80 mmHg) is the most important measure, alongside risk stratification using neuroimaging markers (microbleeds, cortical superficial siderosis) and careful weighing of risks/benefits before resuming anticoagulant or antiplatelet therapy.
