Treatment of intraventricular hemorrhage with urokinase : effects on 30-Day survival.
OBJECTIVE
Intraventricular hemorrhage (IVH) remains associated with high morbidity and mortality. Therapy with external ventricular drainage alone has not modified outcome in these patients.


METHODS
Twelve pilot IVH patients who required external ventricular drainage were prospectively treated with intraventricular urokinase followed by the randomized, double-blinded allocation of 8 patients to either treatment or placebo. Observed 30-day mortality was compared with predicted 30-day mortality obtained by use of a previously validated method.


RESULTS
Twenty patients were enrolled; admission Glasgow Coma Scale score in 11 patients was </=8; 10 patients had pulse pressure <85 mm Hg. Mean+/-SD ICH volume in 16 patients was 6.21+/-7.53 cm(3) (range 0 to 23.88 cm(3)), and mean+/-SD intraventricular hematoma volume was 44.26+/-31.65 cm(3) (range 1.31 to 100.36 cm(3)). Four patients (20%) died within 30 days. Predicted mortality for these 20 patients was 68.42% (range 3% to 100%). Probability of observing </=4 deaths among 20 patients under a 68.42% expected mortality is 0.000012.


CONCLUSIONS
Intraventricular urokinase may significantly improve 30-day survival in IVH patients. On the basis of current evidence, a double-blinded, placebo-controlled, multicenter study that uses thrombolysis to treat IVH has received funding and began January 1, 2000.
Naff
N J
NJ
Division of Neurosurgery, Walter Reed Army Medical Center, Washington DC, USA.
Carhuapoma
J R
JR
Williams
M A
MA
Bhardwaj
A
A
Ulatowski
J A
JA
Bederson
J
J
Bullock
R
R
Schmutzhard
E
E
Pfausler
B
B
Keyl
P M
PM
Tuhrim
S
S
Hanley
D F
DF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D002552:Cerebral Ventricles / Q000098:blood supply*; D014695:Cerebral Ventriculography; D004311:Double-Blind Method; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D010919:Placebos; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator