Antithrombin Therapy for Intracerebral Hemorrhage

Abstract

To the Editor: We read the article by Xi et al1 and the Editorial Comment by Dr J. Paul Muizelaar with great interest. In the article the authors stress that blood clot formation is required for the rapid development of persistent edema in the white and gray matter surrounding intracerebral bleeding. Thrombin itself was found to contribute to prolonged edema in gray matter. Muizelaar cautioned that the experimental findings may not be applicable to clinical practice, making the points that the hematoma is difficult to remove in the early phase after intracerebral hemorrhage (ICH) and that tissue plasminogen activator (tPA) may worsen hemorrhage.We propose consideration of antithrombin therapy with use of a selective thrombin inhibitor such as argatroban to avoid such problems. Argatroban differs from tPA in that it has no effect on the fibrolytic system, so it does not promote bleeding. We suggest that …