Urokinase in the Treatment of Intraventricular Hemorrhage

Abstract

Large, randomized, double-blind trials on the use of urokinase for IVH are not available, and the studies published in the literature are not without flaws. However, it appears that in the current case-control reports, administration of urokinase through ventricular catheters is safe and is a promising alternative to current medical or surgical management. Investigation of other fibrinolytic agents such as recombinant alteplase is available, but is even more limited. Further trials will help to determine the best dosage and duration of urokinase therapy, as well as the overall efficacy of this new treatment option.

Intraventricular Thrombolysis Speeds Blood Clot Resolution: Results of a Pilot, Prospective, Randomized, Double-blind, Controlled Trial

“…Indeed, several clinical series and animal experimental studies have suggested that there is a therapeutic benefit of intraventricular thrombolysis with intraventricular injections of a thrombolytic agent (1, 2, 7-10, 12-14, 17, 18, 20, 23, 24, 27, 28, 30, 32). Because of encouraging published results, the clinical use of both tissue plasminogen activator (tPA) (Alteplase; Genentech, South San Francisco, CA) and urokinase (Abbokinase; Abbott Laboratories, North Chicago, IL) for the off-label NEUROSURGERY VOLUME 54 | NUMBER 3 | MARCH 2004 | 577 indication of intraventricular thrombolysis has increased (11,19). The putative benefits of this therapy, however, must be carefully weighed against the potential danger of injecting a thrombolytic agent into the ventricles of a patient who has recently experienced intracranial hemorrhage (26).…”

Clinical Practice Guidelines for the Medical and Surgical Management of Primary Intracerebral Hemorrhage in Korea

“…Thus, the administration of fibrinolytic agents through a VC has attracted a lot of attention recently. Several reports from animal studies and clinical series suggested that intraventricular administration of fibrinolytic agents, including urokinase, streptokinase, and recombinant tPA, may reduce morbidity and mortality by accelerating blood clearance in IVH21,43,55,56,58,62). The Clot Lysis, Evaluating Accelerated Resolution of IVH (CLEAR-IVH) Trial, prospectively was designed to evaluate the safety and efficacy of using 1.0 mg injections of recombinant tPA through an EVD every 8 hours up to 9 doses to accelerate lysis and evacuation of the IVH, and is still ongoing48).…”

Postoperative Reduction of Intraventricular Hemorrhage Volume: Single- Versus Dual-Catheter Drainage

“…[5][6][7] It was observed that functional outcome and mortality remained unchanged in the last 20 to 30 years. 5,[8][9][10][11][12] Intracerebral hemorrhage (ICH) with extensive ventricular extension has a high morbidity and mortality rate. 1,4,11,12 IVHs caused by ICH initially present with a focal neurologic deficit of sudden onset that progresses gradually (from minutes to hours) as compared with other subtypes of strokes.…”

“…5,[8][9][10][11][12] Intracerebral hemorrhage (ICH) with extensive ventricular extension has a high morbidity and mortality rate. 1,4,11,12 IVHs caused by ICH initially present with a focal neurologic deficit of sudden onset that progresses gradually (from minutes to hours) as compared with other subtypes of strokes. 13,14 The IVH patients are at higher risk and have threefold higher mortality rates than those with ICH only.…”