Hemorrhagic strokes (aka intracerebral hemorrhage) caused by uncontrolled bleeding into the brain tissue from the rupture of diseased blood vessels account for 10-20% of all strokes. Hemorrhagic strokes have the greatest level of mortality amongst all stroke subtypes, averaging 55% at 1 year, and only one quarter of hemorrhagic stroke victims resume independent life. In contrast to the significant reductions in the incidence of ischemic stroke achieved over the past four decades, the incidence of hemorrhagic stroke has remained the same during this time. Moreover, proven treatments or prevention strategies for hemorrhagic stroke patients are limited. This is reflected in the lack of firm clinical guidelines for the management of patients with hemorrhagic stroke. Despite this lack of progress, clinical trials directly targeting patients with hemorrhagic stroke are underrepresented amongst ongoing stroke trials. Continuing to group hemorrhagic strokes into broader stroke trials, where they account for a small fraction of the entire population studied, is unlikely to provide us with any additional insights, particularly in view of the different vascular changes underlying hemorrhagic stroke, their distinctive pathways that illicit brain injury, and differing processes and timeframes involved in stroke recovery.

The Canadian stroke community has a well-established track record for leading pioneering stroke trials that have revolutionized the care of stroke patients worldwide. It is time to begin concentrating our collective strengths and multidisciplinary efforts towards filling this significant gap in stroke patient care. Towards this end, the Canadian HEmorrhagic Stroke trIals initiatiVE (CoHESIVE) is a Canada-centric international multidisciplinary network of collaborators devoted to the development, and successful and efficient execution of hemorrhagic stroke trials.

The objectives of the CoHESIVE include:

  1. Improving our understanding of bleeding in the brain and the resulting mechanisms of brain injury and recovery.
  2. Developing proven prediction tools and prevention strategies for hemorrhagic stroke.
  3. Producing effective acute treatments aimed at minimizing brain injury from hemorrhagic stroke.
  4. Addressing ongoing dilemmas regarding the risk-benefit analysis of using blood thinning and cholesterol lowering medications in patients with hemorrhagic stroke.
  5. Optimizing physical and mental recovery following hemorrhagic stroke.
  6. Enhancing community awareness and education.

The CoHESIVE inaugural symposium was held on June 9th, 2017 at the Population Health Research Institute in Hamilton, Ontario. The network has since grown to include 50+ investigators from 4 countries and oversees 8 national/international hemorrhagic stroke trials being conducted at over 20 academic hospitals from coast-to-coast across Canada.


Population Health Research Institute in Hamilton, Ontario