Association Between Intraventricular Alteplase Use and Parenchymal Hematoma Volume in Patients With Spontaneous Intracerebral Hemorrhage and Intraventricular Hemorrhage

Witsch, Jens; Roh, David; Avadhani, Radhika; Merkler, Alexander E; Kamel, Hooman; Awad, Issam A.; Hanley, Daniel F.; Ziai, Wendy; Murthy, Santosh B.

doi:10.1001/jamanetworkopen.2021.35773

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…In addition, studies investigating the efficacy of fibrinolytic agents, such as recombinant tissue plasminogen activator, in patients with IVH have also reported similar findings. 17,18 According to the CLEAR III trial, the removal of >80% of the initial IVH volume resulted in less disability; however, the mean IVH removal rate in the study was only 65% in the fibrinolytic group. 19 This result implies that the confounding influence of the residual IVH could have concealed positive effects on the study outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Urokinase administration for intraventricular hemorrhage in adults: A retrospective analysis of hemorrhage volume reduction and clinical outcomes

Li,

Yang,

Cheng

et al. 2023

Journal of the Chinese Medical Association

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Background: Intraventricular hemorrhage (IVH) is a type of ventricular bleeding that results in significant morbidity and mortality. Multiple studies have investigated the use of urokinase in IVH treatment. The use of urokinase may lead to higher rates of hematoma resolution and lower mortality rates. However, further studies are required to determine efficacy of urokinase administration. This study examined the association between urokinase use, IVH volume reduction, and clinical outcomes. Methods: In total, 94 adult patients with hypertensive intracerebral hemorrhage (ICH) with ventricular extension or primary IVH were enrolled between 2015 and 2021. Participants were categorized into two groups: "EVD combined with fibrinolysis" and "EVD only." The primary objective was to assess the reduction of IVH severity. Additionally, the study evaluated the functional outcomes and shunt dependency rate as secondary outcomes. Non-contrast computed tomography scans were obtained to measure the severity of IVH using the mGRAEB score. The main outcomes were the association among urokinase administration, reduced IVH severity, and functional outcomes. Results: There were no significant differences in the reduction rate of mGRAEB scores within a 7-day period (−50.0 [−64.4 - −32.5] % vs −44.2 [−59.3 - −7.9] %; p = .489). In addition, investigation of the 3 rd and 4 th ventricles showed similar findings between the two groups. Urokinase treatment was not associated with significant differences in the modified Rankin Scale (5.0 (4.0–5.0) vs. 4.5 (4.0-5.0), p = .674) or shunt dependency rate (33.3% vs 39.3%, p = .58). Conclusion: This study found that intraventricular urokinase use in patients with IVH was not associated with reduced IVH severity. In addition, urokinase use was not associated with better functional outcomes or minor shunt dependency rates.

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Section: Discussionmentioning

confidence: 99%

“…In addition, studies investigating the efficacy of fibrinolytic agents, such as recombinant tissue plasminogen activator, in patients with IVH have also reported similar findings. 17,18…”

Section: Discussionmentioning

confidence: 99%

Urokinase administration for intraventricular hemorrhage in adults: A retrospective analysis of hemorrhage volume reduction and clinical outcomes

Li,

Yang,

Cheng

et al. 2023

Journal of the Chinese Medical Association

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“…Reducing the volume of intraventricular blood can reduce the volume of haematoma in brain parenchyma. 12 , 13 The coagulation cascade reaction is one of the important mechanisms. After blood enters the ventricle, the coagulation and fibrinolysis systems are activated, and thrombin induces astrocyte proliferation and destroys the blood–brain barrier, causing vascular oedema.…”

Section: Discussionmentioning

confidence: 99%

High Levels of D-Dimer are Associated with Poor Hospitalization Outcome of Spontaneous Intraparenchymal Haemorrhage

Chen¹,

Shi²,

Huang³

2022

NDT

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Objective To investigate whether D-dimer levels and changes in D-dimer levels can be used as effective indexes to evaluate the risk of death among intraparenchymal haemorrhage (IPH) patients. Methods A retrospective cohort study of 732 patients with IPH was conducted at an academic medical centre. The risk factors for adverse hospitalization outcomes were analysed, and logistic multivariate analysis was performed. Patients were divided into supratentorial, brainstem and cerebellum groups. According to whether intraventricular haematoma (IVH) and subarachnoid haematoma (SAH) co-occurred, the supratentorial group was divided into simple haematoma, combined IVH, combined SAH and combined IVH+SAH subgroups. The relationship between D-dimer levels and hospitalization outcome in each group/ subgroup was analysed. Results Compared with survivors, the plasma D-dimer level of the nonsurvivors on the second day after admission was significantly higher (2.52 ± 3.89 μg/mL vs 0.77 ± 2.31 μg/mL, P = 0.032), and the difference in plasma D-dimer levels between the second day after admission and admission significantly increased (1.77 ± 3.70 μg/mL vs 0.26 ± 2.80 μg/mL, P = 0.049), and a D-dimer level on day 2 > 0.58 μg/mL was an independent risk factor for mortality among IPH patients (OR 3.114, 95% CI: 1.007). In the supratentorial group and the IVH subgroup, the level of D-dimer on day 2 was significantly higher among nonsurvivors than among survivors (2.18 ± 2.13 μg/mL vs 0.65 ± 1.04 μg/mL, P = 0.011; 2.45 ± 2.31 μg/mL vs 0.91 ± 1.26 μg/mL, P = 0.028, respectively). Conclusion The increase in plasma D-dimer levels on day 2 is related to poor hospitalization outcomes of patients with IPH, and this correlation may exist only among patients with both IVH and IPH.

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“…Another issue while managing patients with EVD is regarding the decision to administer a thrombolytic agent that facilitates CSF clearance of intraventricular blood. Several clinical trials provide contradictory information on the e cacy of intraventricular t-PA in patients with IVH 29,[33][34][35] . In this study, we aimed to develop a biomarker to calculate the daily rate of ventricular drainage among ICH patients with IVH, with and without EVD.…”

Section: Introductionmentioning

confidence: 99%

Serial Diffusion Tensor Imaging and Rate of Ventricular Blood Clearance in Patients with Intraventricular Hemorrhage

Vyas,

Savitz,

Boren

et al. 2024

Preprint

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Background: Intraventricular hemorrhage (IVH), a predictor of a poor prognosis and high mortality, typically requires external ventricular drains (EVD). However, there is no method to measure the rate of ventricular blood clearance. Blood in the ventricles increases cerebral spinal fluid (CSF) viscosity and decreases the diffusion coefficient. We hypothesize that change in DTI metrics, fractional anisotropy (FA), and mean diffusivity (MD), can be used as a marker for ventricular blood clearance. Method: 26 ICH patients with IVH were imaged on an MRI at 1, 14, 28, and 42 days. Ventricular blood volume (VBV), FA, and MD were calculated. Contralateral ventricular CSF served as control. Clinical assessment (NIHSS), and baseline Glasgow coma score (GCS) were associated with FA, MD, and VBV. Generalized linear mixed models assessed changes. Results: Average hematoma volume (HV) and NIHSS at day 1 was 14.6±16.7 cc and 16±8. HV and VBV resolution rates per day were 2.1% and 1.3%, respectively. Ipsilesional ventricular FA (vFA) significantly decreased (0.24 to 0.15, 1.3% per day, PP>99%), and MD increased (MD=1540*10-6 to 2516*10-6mm2/sec, 1.5% per day, PP>99%) over 6 weeks. Patients with EVD exhibited a faster decline in ipsilesional vFA (1.5% vs. 1.1% per day) and an increase in MD (1.8% vs. 1.5% per day) compared with non-EVD patients. Ipsilesional vFA associated with VBV; a 1.00 cc increase of blood resulted in a 5.2% decrease in ventricular CSF diffusion coefficient. VBV was strongly associated with NIHSS (PP= 97-99%). A larger drained CSF volume was associated with a greater decrease (PP=83.4%) in FA; a smaller drained volume showed greater increases (PP=94.8%) in MD. Slower restoration of vFA and MD suggests obstruction. Conclusion: We developed a non-invasive marker that shows ventricular FA and MD are strongly associated with HV, VBV, and can be used to quantify the rate of ventricular blood clearance.

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Association Between Intraventricular Alteplase Use and Parenchymal Hematoma Volume in Patients With Spontaneous Intracerebral Hemorrhage and Intraventricular Hemorrhage

Abstract: This cohort study evaluates the mortality and functional outcome in patients with spontaneous intracerebral hemorrhage who received intraventricular alteplase vs those who received saline.

Cited by 9 publications

References 19 publications

Urokinase administration for intraventricular hemorrhage in adults: A retrospective analysis of hemorrhage volume reduction and clinical outcomes

Urokinase administration for intraventricular hemorrhage in adults: A retrospective analysis of hemorrhage volume reduction and clinical outcomes

High Levels of D-Dimer are Associated with Poor Hospitalization Outcome of Spontaneous Intraparenchymal Haemorrhage

Serial Diffusion Tensor Imaging and Rate of Ventricular Blood Clearance in Patients with Intraventricular Hemorrhage

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