Treatment of Intraventricular Hemorrhage (IVH) by Injection of Recombinant Tissue-type Plasminogen Activator (rtPA)–Single Institution Experiences with 80 Patients

Abstract

Introduction: The aim of our study was to present the results of intraventricular injection of recombinant tissuetype plasminogen activator (rtPA) in patients suffering from intraventricular hemorrhage (IVH). Material and methods: Patients with spontaneous IVH were enrolled in the study during 2006-2010. A rigid external ventricular drainage (EVD) was implanted via left or right sided frontal burr holes. 3 mg rtPA was injected each day over the EVD for three consecutive days. Hemorrhage size was determined by daily CT scanning. Classification of IVH was done using the IVH scoring system. The clinical condition was classified using the Glasgow coma scale (GCS) and Glasgow outcome scale (GOS). Statistical analysis (Fisher’s exact and χ²-Test) was done for various parameters to analyze their impact on outcome. Results: Eighty patients were included to the study (45 male, 35 female). At time of admission 49 patients (56.3%) were in a poor (GCS ≤ 8), 14 (17.5%) in an intermediate (GCS 9-12) and 17 (21.3%) in a good condition (GCS ≥ 13). In the majority of all cases clot lysis could reach a reduction of over 66%. However, clot lysis alone did not lead to a statistically significant reduction of morbidity and mortality (p>0.05). Poor GCS grade and age >70 years were statistically significant for poor outcome. Conclusion: Intraventricular application of rt-PA as a minimal invasive treatment modality seems to be suitable for clearance of the blood clots from the ventricles. Despite our mainly good and successful volume reduction, clot lysis alone did not influence the outcome positively. Its usage should be considered in view of different predictive factors. Large Prospective and randomized trials are necessary to answer the open questions.