After Spontaneous ICH, Does Earlier rFVIIa Improve Outcomes?

Spontaneous intracerebral hemorrhage (ICH) is associated with substantial morbidity and mortality, and few treatments are effective. The FAST trial was a well-conducted study of the hemostatic agent recombinant activated factor VIIa (rFVIIa), administered within 4 hours of onset, that demonstrated significantly reduced hematoma growth but no functional improvement and more thromboembolic complications. The current FASTEST trial tested whether even earlier administration of rFVIIa — within 2 hours of onset — improves functional outcomes.

FASTEST was a double-blind trial in which 600 adults with ICH between 2 and 60 ml presenting to 93 international sites were randomly assigned to receive rFVIIa or placebo.