title: Intraventricular fibrinolysis does not increase perihemorrhagic edema after intracerebral hemorrhage.
abstract: OBJECTIVE
  Additional intraventricular hemorrhage leads to higher mortality and worse functional outcome after intracerebral hemorrhage (ICH). Intraventricular fibrinolysis (IVF) with recombinant tissue plasminogen activator (rtPA) is an emerging treatment strategy for such patients. However, experimental studies suggest that rtPA may exert proedematous effects and lead to increased perihemorrhagic edema (PHE) after ICH. We aimed to compare the course of PHE after ICH between patients who received IVF with rtPA and controls matched for ICH volume.
  
  
  METHODS
  Patients were identified retrospectively from our institutional ICH database. Sixty-four patients with ICH and intraventricular hemorrhage who were treated with IVF were compared with 64 controls, who did not receive IVF, matched for ICH volume. The course of PHE was assessed on computed tomography scans (day 1, days 2 and 3, days 4-6, 7-9, and 10-12) using a threshold-based semiautomatic volumetric algorithm. Relative PHE was calculated as a ratio of PHE volume and initial ICH volume.
  
  
  RESULTS
  The matching algorithm resulted in similar mean ICH volumes in both groups (20.01 ± 17.5 mL, IVF vs 20.08 ± 17.1 mL, control). Intraventricular hemorrhage volume was larger in the IVF group (26.8 ± 19.2 mL vs 9.2 ± 13.4 mL). The mean total rtPA dose used for IVF was 8 ± 6 mg. PHE increased over time in both groups until day 12. At all investigated time points, there was no significant difference in relative PHE between the IVF group and controls (F=0.39; P=0.844).
  
  
  CONCLUSIONS
  IVF with rtPA did not lead to a relevant increase in PHE after ICH. rtPA doses used in the current study seem to be safe regarding PHE.
authors.affiliation: Department of Neurology, University of Erlangen-Nure, Schwabachanlage 6, 91054 Erlangen, Germany. bastian.volbers@uk-erlangen.de
authors.forename: Bastian
authors.initials: B
authors.lastname: Volbers
authors.forename: Ingrid
authors.initials: I
authors.lastname: Wagner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Willfarth
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Dimitre
authors.initials: D
authors.lastname: Staykov
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects / Q000502:physiology; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007276:Injections, Intraventricular; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator