According to an editorial, the strategy of testing a plausible pathophysiological hypothesis in a highly selected population of patients with intracerebral haemorrhage (ICH) seems interesting from a theoretical point of view, but the rapidity of enrolment may have come with a cost: the underlying vessel disease has not been identified. It discusses whether the heterogeneity of underlying vessel disease (cerebral amyloid angiopathy, deep perforating vasculopathy, haemorrhagic infarcts) mitigated the efficacy of a haemostatic strategy.
It suggests that for future trials, researchers will have to choose between two philosophical approaches: a small, hyperselected population to prove efficacy, but what about applicability or large, heterogeneous populations to prove generalisability—that may be challenging to prove efficacy. It adds that despite the negative results of interventional studies testing haemostatic agents in ICH, there are reasons to be optimistic for the future.