Abstract WMP107: Efficacy of Intraventricular Administration of Alteplase for Intraventricular Hemorrhage

Abstract

Introduction: The efficacy of extraventricular drain (EVD) alone was compared to EVD with intraventricular alteplase injection for the treatment of intraventricular hemorrhage (IVH) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) cohort. Methods: ERICH study subjects with IVH and EVD placement were dichotomized by alteplase administration. Propensity score modeling was used to adjust for significant differences in baseline variables and included age, gender, race/ethnicity, initial Glasgow Coma Scale (GCS) score, ICH location, initial ICH volume, primary IVH, and initial IVH volume (Table 1). Outcome measures included 3, 6, and 12-month modified Rankin scale (mRS) as well as IVH volume change on follow-up head CT within 24 hours. Good outcome was defined as a mRS <=3. Mann-Whitney U and Chi-squared tests were utilized for statistical analyses. Results: Follow-up mRS scores at 3, 6, and 12 months were not significantly different between the two groups. Compared to the initial head CT on presentation, a significant reduction of IVH volume was seen on the subsequent head CT (Table 2). Conclusion: For ERICH subjects with IVH and EVD placement, the administration of intraventricular alteplase resulted in significant IVH volume reduction. The sample size, however, was likely insufficient to detect a difference between mRS outcomes. Our findings in this non-randomized IVH cohort highlight real world clinical practice outcomes and are consistent with the results of CLEAR III.