title: Intraventricular fibrinolysis for severe aneurysmal intraventricular hemorrhage: a randomized controlled trial and meta-analysis.
abstract: The aim of this study was to assess the safety and efficacy of intraventricular fibrinolysis (IVF) for aneurysmal subarachnoid hemorrhage (aSAH) with severe intraventricular hemorrhage (IVH). In this randomized controlled trial, between 2005 and 2009, patients with aSAH and severe IVH were randomly assigned into two groups: one treated with external ventricular drainage (EVD) combined with intraventricular recombinant tissue plasminogen activator (rt-PA) and the second with EVD alone. The primary end-point was mortality rate within the first 30 days. We performed meta-analysis including all published articles that compared IVF + EVD to EVD alone in patients with aSAH IVH. Eleven patients were included in the rt-PA group, eight in the control group. At 30 days, mortality rate was lower in the rt-PA group (45.5 vs. 62.5%), but results were not statistically significant (p = 0.65). Clearance of third and fourth ventricles was obtained previously in the rt-PA group (4.25 days) compared to the control group (10.67 days) (p = 0.001). There was no statistically significant difference concerning the occurrence of complications. The meta-analysis showed a better survival rate with IVF without raised statistical significance (odds ratio = 0.32 [95% confidence interval, 0.10-1.03]). This study shows that IVF is as safe as EVD alone for aSAH with severe IVH. It accelerates blood clot resolution in the ventricular system. Mortality rate could be improved by IVF but without significant results. Because of the severity and rarity of this pathology, a multicenter study is required.
  
  
  BACKGROUND
  www.clinicaltrials.gov (NCT00823485).
authors: Department of Neurosurgery, University Hospital of Nice, Hôpital Pasteur, avenue de la voie Romaine, Nice, France.
authors: Stephane
authors: S
authors: Litrico
authors: Fabien
authors: F
authors: Almairac
authors: Thomas
authors: T
authors: Gaberel
authors: Rohan
authors: R
authors: Ramakrishna
authors: Denys
authors: D
authors: Fontaine
authors: Jacques
authors: J
authors: Sedat
authors: Michel
authors: M
authors: Lonjon
authors: Philippe
authors: P
authors: Paquis
mesh_terms: D000328:Adult; D000368:Aged; D002552:Cerebral Ventricles; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D016017:Odds Ratio; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000453:epidemiology / Q000209:etiology
chemical_list: D010959:Tissue Plasminogen Activator
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