Introduction

In a compelling interview with Pharmacy Times®, Dr. Kara Melmed, a neurointensivist and assistant professor at NYU Langone Health, reveals groundbreaking strategies for treating intracerebral hemorrhage (ICH). During a vibrant debate at the American Academy of Neurology 2025 Annual Meeting in San Diego, Dr. Melmed advocated for a proactive “Code ICH” approach that unites all healthcare professionals around the patient for immediate action—specifically targeting rapid blood pressure reduction and the reversal of anticoagulation therapies.

The Importance of Timely Intervention

Dr. Melmed underscored the critical importance of the "time is brain" principle, emphasizing that aggressive interventions need to occur as swiftly as possible after a patient's arrival. She outlined a goal of managing blood pressure within 60 minutes and achieving anticoagulation reversal within 90 minutes of arrival. This urgent call to action highlights the severe consequences that can arise from delayed treatment in patients experiencing ICH.

Advocating for a Multidisciplinary Approach

“What we are advocating for is much like the protocol already established for ischemic strokes,” said Dr. Melmed. “We need to take an urgent multidisciplinary approach that keeps every key player at the bedside, ensuring that immediate care is provided.”

The Role of Pharmacists

She further elaborated on how pharmacists, often overlooked in acute care situations, are pivotal in this rapid response. “Pharmacists must play an active role in managing blood pressure, choosing appropriate medications, and facilitating anticoagulation reversal,” Dr. Melmed stated. “Whether using intravenous or oral agents, their expertise is vital to the efficacy and speed of treatment.”

Key Points Raised by Dr. Melmed

1. **Implement a “Code ICH” model**: This involves integrating a team of healthcare professionals who can collaboratively manage the immediate needs of the patient.

2. **Aggressive Blood Pressure Management**: Strive for a door-to-blood pressure treatment time of 60 minutes and antifibrillatory reversal within 90 minutes.

3. **Community-Based Preventive Care**: Emphasize the importance of lifestyle changes and medication adherence to reduce future ICH incidents.

Looking Forward

Dr. Melmed is optimistic that these practices can become the standard across medical institutions in the U.S., particularly with the support of organizations such as the American Heart Association (AHA).

Addressing Preventive Measures

In addition to the immediate care necessary during an ICH incident, Dr. Melmed pointed out that preventive measures, such as effective blood pressure control and diabetes management, should be addressed in community pharmaceutical care settings. This broader perspective aims to significantly reduce the incidence of intracerebral hemorrhages.

Conclusion

“The inclusion of pharmacists in the management of our patients during ICH events is essential,” she reiterated. “We all must focus on achieving optimal outcomes. As caregivers, we really need to be there for our patients through every critical moment.”

The stakes couldn't be higher: effective and timely intervention in ICH not only improves immediate outcomes but potentially saves lives in the long run. As the healthcare community continues to explore ways to refine ICH treatment, the call for “Code ICH” represents a bold step toward enhancing patient care through teamwork, speed, and efficiency.