title: Intraventricular fibrinolysis versus external ventricular drainage alone in intraventricular hemorrhage: a meta-analysis.
abstract: OBJECTIVE
  The purpose of this study was to analyze the effect of intraventricular fibrinolysis (IVF) compared with external ventricular drainage alone on mortality and functional outcome in the management of intraventricular hemorrhage secondary to spontaneous supratentorial intracerebral hemorrhage.
  
  
  METHODS
  The authors conducted a systematic review and performed a meta-analysis. They reviewed the PubMed, Cochrane Library, and Liliacs databases. In addition, they conducted a manual review of article bibliographies.
  
  
  RESULTS
  Using a prespecified search strategy, 4 randomized and 8 observational studies were included in a meta-analysis. These studies involved a total of 316 patients with intraventricular hemorrhage at baseline, of whom 167 had IVF (52.8%). Pooled odds ratios of the impact of IVF on patient mortality, functional outcomes, and complications were calculated. The overall mortality risk decreased from 46.7% in the external ventricular drainage alone group to 22.7% in the external ventricular drainage+IVF group, corresponding to an overall pooled Peto OR of 0.32 (95% CI, 0.19 to 0.52). This result was highly significant with urokinase, not with recombinant tissue-type plasminogen activator. IVF was also associated with an increase in good functional outcome. There was no difference between the 2 groups in terms of shunt dependence and complications.
  
  
  CONCLUSIONS
  The combination of IVF and external ventricular drainage in the management of severe intraventricular hemorrhage secondary to small intracerebral hemorrhage in young patients was associated with better survival and functional outcome results. Urokinase and recombinant tissue-type plasminogen activator could not have the same therapeutic effects. Well-designed randomized trials with special considerations to the fibrinolytic agents are needed.
authors.affiliation: Department of Neurosurgery, Caen University Hospital, and Sérene Protease and Pathophysiology of the Neurovascular Unit, Centre d'Imagerie et de Neurosciences Appliquées aux Pathologies, University Caen Lower Normandy, Avenue de la Cote de Nacre, Caen, F-14000, France. thomas.gaberel@hotmail.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaberel
authors.forename: Cristian
authors.initials: C
authors.lastname: Magheru
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.forename: Hagen Bernhard
authors.initials: HB
authors.lastname: Huttner
authors.forename: Denis
authors.initials: D
authors.lastname: Vivien
authors.forename: Evelyne
authors.initials: E
authors.lastname: Emery
mesh_terms: D002543:Cerebral Hemorrhage / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D002552:Cerebral Ventricles / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007276:Injections, Intraventricular; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator