Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase

Akdemir, Hidayet; Selçuklu, Ahmet; Paşaoğlu, Aydın; Is, Oktem; Kavuncu, İkram

doi:10.1007/bf00417665

Cited by 58 publications

(39 citation statements)

References 17 publications

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“…Fourteen of these studies assessed only a single treatment strategy: eight conservative treatment, three EVD, and three EVD combined with fibrinolytic agents. Four studies compared two treatment strategies: two EVD and conservative treatment (nonrandomized) [22,23], one EVD and EVD combined with fibrinolysis (nonrandomized) [2], and one EVD combined with fibrinolysis and a historical control group treated by EVD [18]. Ten studies were retrospective, seven were prospective, and one used a retrospective control group and a prospective intervention group [18].…”

Section: Resultsmentioning

confidence: 99%

Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: a systematic review of the literature

Nieuwkamp¹,

Gans²,

Rinkel³

et al. 2000

J Neurol

176

106

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Severe intraventricular hemorrhage caused by extension from subarachnoid hemorrhage or intracerebral hemorrhage leads to hydrocephalus and often to poor outcome. We conducted a systematic review to compare conservative treatment, extraventricular drainage, and extraventricular drainage combined with fibrinolysis. We carried out a search in Medline of the literature between January 1966 and December 1998 and an additional hand-search from January 1990 to December 1998. Pharmaceutical companies were contacted to gather unpublished data. We reviewed the reference lists of all relevant articles. Two authors independently assessed eligibility of the studies and extracted data on characteristics of study design, patients, and treatment. Patients with primary intraventricular hemorrhage were excluded. Main outcome measures were death and poor outcome (defined as death or dependency) at the end of follow-up. No randomized clinical trial has yet been conducted so far, and we therefore reviewed only observational studies. The case fatality rate for conservative treatment (ten studies) was 78%. For extraventricular drainage (seven studies) it was 58% [relative risk versus conservative treatment (RR) 0.74; 95% confidence interval (CI) 0.55-0.99]. For extraventricular drainage with fibrinolytic agents (five studies) the case fatality rate was 6% (RR 0.08; 95% CI 0.02-0.24). The poor outcome rate for conservative treatment was 90%, that for extraventricular drainage 89% (RR 0.98; 95% CI 0.75-1.30) and that for extraventricular drainage with fibrinolytic agents 34% (RR 0.38; 95% CI 0.21-0.68). All RR values remained essentially the same after adjusting for age, sex, World Federation of Neurological Surgeons scale, study design, and year of publication for the studies that provided these data. Outcome is thus poor in patients with intraventricular extension of subarachnoid or intracerebral hemorrhage. This meta-analysis suggests that treatment with ventricular drainage combined with fibrinolytics may improve outcome for such patients, although this impression is derived only from an indirect comparison between observational studies. A randomized clinical trial is warranted.

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Section: Resultsmentioning

confidence: 99%

Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: a systematic review of the literature

Nieuwkamp¹,

Gans²,

Rinkel³

et al. 2000

J Neurol

176

106

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“…Other series 9,12,[15][16][17][18] have reported a combined total of 59 patients given intraventricular thrombolytics for spontaneous IVH from either aneurysmal or presumed parenchymal rupture; of these, 17 received UK. 9,12,15 None of these series looked at the same outcome measures we used (eg, LOS), nor did any have a sizable contemporaneous cohort managed without adjunctive thrombolytics.…”

Section: Discussionmentioning

confidence: 99%

A Cohort Study of the Safety and Feasibility of Intraventricular Urokinase for Nonaneurysmal Spontaneous Intraventricular Hemorrhage

Coplin

Viñas

Agris

et al. 1998

Stroke

121

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Background and Purpose-Small case series have reported potential benefit from thrombolysis after spontaneous intraventricular hemorrhage (IVH). Our objective was to review our experience using intraventricular urokinase (UK) in treating selected patients with IVH. Methods-Using medical records, we identified all patients who received ventriculostomies for CT-confirmed nonaneurysmal nontraumatic spontaneous IVH from December 1992 through November 1996. We reviewed charts and CT images and examined the data for associations with specific outcomes. Results-We identified 40 patients, 18 treated with ventriculostomy alone and 22 receiving adjunctive intraventricular UK.The initial Glasgow Coma Scale (GCS) scores of the two groups were similar (Pϭ0.5). While there was a trend for patients with any intraparenchymal hemorrhage (IPH) to receive UK (Pϭ0.07), the mean size of IPH in those who received ventriculostomy alone was larger than in those who received adjunctive UK (Pϭ0.002). There was lower mortality in the group treated with UK (31.8 versus 66.7%; Pϭ0.03), but there was only a trend toward an increase in favorable outcome (22.2% versus 36.4%; Pϭ0.3). Overall, the most significant association with outcome was neurological condition at presentation (GCS Ͼ5 versus Յ5; Pϭ0.003). Receiving UK did not increase the occurrence of complications or hospital length of stay for survivors (Pϭ0.5). Conclusions-Intraventricular UK remains a safe and potentially beneficial intervention. While it appeared to lower mortality, a randomized, placebo-controlled trial is needed to explore whether the therapy can increase the incidence of favorable outcomes.

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“…The fibrinolytic agent used was urokinase (n = 134) [12,[19][20][21][22][23][24][25][26][27][28][29][30] or recombinant tissue plasminogen activator (rt-PA, n = 240) [11,. One study reports on the use of streptokinase (n = 14) [23].…”

Section: Available Studies On Ivf In Different Underlying Pathologiesmentioning

confidence: 99%

Intraventricular Fibrinolysis for Intracerebral Hemorrhage with Severe Ventricular Involvement

et al. 2010

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Intraventricular hemorrhage (IVH) has been associated with poor prognosis in patients with spontaneous intracerebral hemorrhage. Several factors contribute to the deleterious effects of IVH, including direct mass effects of the ventricular blood clot on ependymal and subependymal brain structures, mechanical and inflammatory impairment of the Pacchioni granulations by blood and its breakdown products, and disturbance of physiological cerebrospinal fluid (CSF) circulation. Acute obstructive hydrocephalus represents a major life-threatening complication of IVH and is usually treated with an external ventricular drainage (EVD). However, treatment with EVD alone is frequently not sufficiently effective due to obstruction of the catheter by blood. In the past two decades, intraventricular fibrinolysis (IVF) has been increasingly used for maintenance of EVD functionality and acceleration of ventricular clot resolution in such patients. Unfortunately, there is no prospective, randomized controlled trial addressing the effect of IVF on clinical outcome. The available data on IVF consist of small retrospective case series, case reports, and a few prospective case-control studies, which are the subject of the present review article. All these studies, when considered in their entirety, suggest that IVF has a positive impact on mortality and functional outcome, and could be considered as a treatment option for selected patients.

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Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase

Cited by 58 publications

References 17 publications

Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: a systematic review of the literature

Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: a systematic review of the literature

A Cohort Study of the Safety and Feasibility of Intraventricular Urokinase for Nonaneurysmal Spontaneous Intraventricular Hemorrhage

Intraventricular Fibrinolysis for Intracerebral Hemorrhage with Severe Ventricular Involvement

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