title: Intraventricular thrombolysis with rt-PA in patients with intraventricular hemorrhage.
abstract: OBJECTIVE
  To evaluate safety, clinical feasibility, and outcome of intraventricular (IVen) administration of recombinant tissue plasminogen activator (rt-PA) in patients with intraventricular hemorrhage (IVH).
  
  
  METHODS
  Forty-eight patients with IVH who received IVen rt-PA were compared with 49 age-, sex-, Glasgow Coma Scale score-, and Intracerebral Hemorrhage score-matched control patients. Patients with IVH of aneurysmal or arteriovenous malformation origin were excluded. External ventricular drainage was inserted as soon as baseline CT was performed and rt-PA was administered within 12 ± 1 h after the ictal onset.
  
  
  RESULTS
  The outcome after 3 months was evaluated using the modified Rankin Scale (mRS). In addition, Glasgow Outcome Scale (GOS) and mortality were assessed. A good outcome, defined as mRS 0-3, was detected in 27% of patients from the control group vs 58% of patients in the IVen group; P = 0.003. GOS as other outcome scale yielded a significant difference between groups: 20% in the control group, vs 54% in the IVen group; P = 0.001. A statistically significant decrease in mortality was observed in the IVen group: 30% in the control vs 10% in IVen group; P = 0.003. No one patient died because of a complication which could be directly attributed to the IVen thrombolytic therapy.
  
  
  CONCLUSIONS
  IVen administration of rt-PA seems to be safe in cases of IVH. This pilot study shows that it may be associated with better outcomes. Further studies and clinical randomized trials are needed to establish indications and IVen administration protocols.
authors.affiliation: Intensive Care Unit, Department of Neurology, Clinical Hospital Centre Rijeka, Croatia. sinisa.dunatov@ri.t-com.hr
authors.forename: S
authors.initials: S
authors.lastname: Dunatov
authors.forename: I
authors.initials: I
authors.lastname: Antoncic
authors.forename: M
authors.initials: M
authors.lastname: Bralic
authors.forename: A
authors.initials: A
authors.lastname: Jurjevic
mesh_terms: D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D023261:Glasgow Outcome Scale; D006801:Humans; D057967:Infusions, Intraventricular; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator