X marks the ‘spot sign’ in trial of ICH stroke treatment

A blood vessel bursts in someone’s brain every five minutes in Canada. Known as an intracerebral hemorrhage (ICH), there is no good treatment for this deadly form of stroke. 

An international clinical trial published in The Lancet found a clotting compound called factor VIIa improved the outcomes of patients with ICH who had ‘spot signs’ on their CT scans. Patients without the sign saw no benefit.

The “spot sign” represents a growing pool of blood in the brain. Found in 10 to 30 percent of people with ICH, it predicts poor outcomes. 

Some stroke neurologists like Dr. Dar Dowlatshahi have argued the spot sign means the brain is still bleeding, and that stopping the bleeding should improve patient outcomes. Factor VIIa might do just that.

“Overall, the trial found no difference between the drug and placebo. But it’s opened the door to what could be a more targeted treatment for certain patients,” said Dr. Dowlatshahi, stroke neurologist and senior scientist at The Ottawa Hospital and professor at the University of Ottawa. “When we saw that ICH patients with a spot sign given factor VIIa did significantly better, we immediately launched a second trial randomizing only those patients to the drug or placebo. That trial is ongoing.”

Dr. Dowlatshahi was the lead for The Ottawa Hospital site of the trial, which enrolled the first two patients worldwide.