APEX-STROKE EAGLE Domain (EAGLE) (EAGLE)

Inclusion Criteria:

1. Age ≥ 18 years;
2. Confirmed diagnosis of spontaneous supratentorial intracerebral hemorrhage (ICH) via cerebral imaging;
3. Randomization completed within 6 hours of symptom onset (or last known normal state), with the ability to initiate MIS within 8 hours of ICH onset;
4. Hematoma volume ranging from 20 to 80 mL;
5. National Institutes of Health Stroke Scale (NIHSS) score ≥ 8;
6. Glasgow Coma Scale (GCS) score ≥ 8;
7. Provision of written informed consent (or signed by an authorized representative).

Exclusion Criteria:

1. Secondary causes of hemorrhage (e.g., structural abnormalities including arteriovenous malformations, cerebral aneurysms, tumors, trauma) or hemorrhagic transformation of acute ischemic stroke;
2. Isolated intraventricular hemorrhage, or brainstem/cerebellar hemorrhage;
3. Severe chronic kidney disease or liver failure;
4. High risk of mortality within 7 days, or poor adherence to study treatment or follow-up;
5. Severe comorbidities (e.g., cancer, chronic obstructive pulmonary disease, heart failure, significant pre-stroke disability [modified Rankin Scale (mRS) score 3-5]) that may confound outcome assessment;
6. Other conditions judged by the investigator to be unsuitable for MIS (e.g., brain herniation, etc.);
7. Definite indications or contraindications for antihypertensive therapy of different intensities;
8. Specific contraindications to any component of the planned antihypertensive medications (e.g., patients with allergy or hypersensitivity to any ingredient);
9. Patients with contraindications to tranexamic acid (TXA), including: those allergic or hypersensitive to TXA or its excipients, patients with active thrombotic disorders, individuals with hereditary or acquired thrombophilia, patients with subarachnoid hemorrhage, and those with upper urinary tract bleeding complicated by gross hematuria, etc.;
10. Patients known at enrollment to be receiving therapeutic anticoagulation with warfarin or low-molecular-weight heparin (users of direct oral anticoagulants are eligible for inclusion and not excluded).