title: Dose effect of intraventricular fibrinolysis in ventricular hemorrhage.
abstract: OBJECTIVE
  The aim of the current study was to investigate the dose-dependent efficacy of intraventricular fibrinolysis (IVF) in patients with severe intraventricular hemorrhage (IVH).
  
  
  METHODS
  Patients with intracerebral hemorrhage, severe IVH, and obstructive hydrocephalus with the need for external ventricular drainage were treated with IVF through external ventricular drainage. The time course of IVH resolution and the safety profile were compared between patients treated with high-dose IVF (4 mg alteplase every 12 hours, maximum 20 mg; n=32) and low-dose IVF (1 mg alteplase every 8 hours, maximum 12 mg; n=22). CT scans on Days 1 to 4, 7 ± 1 and 10 ± 1 after admission, were analyzed volumetrically. Outcome was assessed after 3 months.
  
  
  RESULTS
  The overall effect of IVF dosage was not significantly different between the 2 groups (F=1.3, P=0.25). The course of IVH volume in the third and fourth ventricles was similar with high- and low-dose IVF. High-dose IVF resulted in lower total IVH volumes on Days 7 (4.4 ± 4.2 mL versus 8.8 ± 8.1 mL; P=0.01) and 10 (1.4 ± 2.8 mL versus 4.9 ± 65.8 mL; P=0.005). Total clot half-life was 78 ± 43 hours in the low-dose and 56 ± 25 hours in the high-dose group (P=0.02). One asymptomatic ventricular bleeding, 2 cases of ventriculitis, and 1 death due to pulmonary embolism occurred in the high-dose group. There was no difference in outcome at 3 months.
  
  
  CONCLUSIONS
  Low-dose IVF (3 mg alteplase/day) has a similar effect on IVH clearance from the third and fourth ventricles and a similar safety profile when compared with high-dose IVF (8 mg alteplase/day).
authors.affiliation: Department of Neurology, University of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany. dimitre.staykov@uk-erlangen.de
authors.forename: Dimitre
authors.initials: D
authors.lastname: Staykov
authors.forename: Ingrid
authors.initials: I
authors.lastname: Wagner
authors.forename: Bastian
authors.initials: B
authors.lastname: Volbers
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Juergen
authors.initials: J
authors.lastname: Bardutzky
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology*; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D006849:Hydrocephalus / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000494:pharmacology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator