Skip to main content

Advertisement

SpringerLink
Log in

Thrombolytics in intraventricular hemorrhage

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Intraventricular hemorrhage (IVH) may occur as an isolated event from primary ventricular bleeding or as a complication of brain hemorrhage from another etiology. It is associated with high mortality and morbidity. Recent translational and clinical studies demonstrate that thrombolytic drugs administered intraventricularly through an external ventricular drain to lyse an IVH clot are safe and may reduce morbidity and mortality. The ongoing, prospective, randomized clinical trial known as Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR IVH) offers new hope for patients with this devastating disease. Preliminary data show marked reduction in time to clot lysis as well as a potential reduction in mortality associated with IVH lysis. A large, phase III, randomized prospective trial to ascertain the true clinical efficacy of this treatment is currently in the planning stages. A review of the use of thrombolytics for treatment of IVH related to other secondary causes is also provided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Adams RE, Diringer MN: Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus. Neurology 1998, 50:519–523.

    PubMed  CAS  Google Scholar 

  2. Daverat P, Castel JP, Dartigues JF, Orgogozo JM: Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. Stroke 1991, 22:1–6.

    PubMed  CAS  Google Scholar 

  3. Tuhrim S, Dambrosia JM, Price TR, et al.: Intracerebral hemorrhage: external validation and extension of a model for prediction of 30-day survival. Ann Neurol 1991, 29:658–663.

    Article  PubMed  CAS  Google Scholar 

  4. Young WB, Lee KP, Passin MS: Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study. Neurology 1990, 40:616–619.

    PubMed  CAS  Google Scholar 

  5. Adams HP, Torner JC, Kassell NF: Intraventricular hemorrhage among patients with recently ruptured aneurysms: a report of the Cooperative Aneurysm Study. Stroke 1992, 23:140.

    Google Scholar 

  6. Tuhrim S, Horowitz DR, Sacher M, et al.: Validation and comparison of models predicting survival following intracerebral hemorrhage. Crit Care Med 1995, 23:950–954.

    Article  PubMed  CAS  Google Scholar 

  7. Naff NJ: Intraventricular hemorrhage in Adults. Curr Treat Options Neurol 1999, 1:173–178.

    Article  PubMed  Google Scholar 

  8. Broderick JP, Brott T, Tomsick T, et al.: Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 1993, 78:188–191.

    PubMed  CAS  Google Scholar 

  9. Mohr G, Ferguson G, Khan M: Intraventricular hemorrhage from ruptured aneurysm. J Neurosurg 1983, 58:482–487.

    PubMed  CAS  Google Scholar 

  10. Qureshi AI, Tuhrim S, Broderick JP, et al.: Spontaneous intracerebral hemorrhage. N Engl J Med 2001, 344:1450–1460.

    Article  PubMed  CAS  Google Scholar 

  11. Pang D, Sclabassi RJ, Horton JA: Lysis of intraventricular blood clo t with urokinase in a canine model: part 1: canine intraventricular blood cast model. Neurosurgery 1986, 19:540–546.

    PubMed  CAS  Google Scholar 

  12. Pang D, Sclabassi RJ, Horton JA: Lysis of intraventricular blood clot with urokinase in a canine model: part 2: in vivo safety study of intraventricular urokinase. Neurosurgery 1986, 19:547–552.

    PubMed  CAS  Google Scholar 

  13. Mayfrank L, Kissler J, Raoofi R: Ventricular dilatation in experimental intraventricular hemorrhage in pigs. Characterization of cerebrospinal fluid dynamics and the effects of fibrinolytic treatment. Stroke 1997, 28:141–148.

    PubMed  CAS  Google Scholar 

  14. Wang YV, Lin CW, Shen CC, et al.: Tissue plasminogen activator for the treatment of intraventricular hematoma: the dose effect relationship. J Neurol Sci 2002, 202:35–41.

    Article  PubMed  CAS  Google Scholar 

  15. Tuhrim S, Horowitz DR, Sacher M, Godbold JH: Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med 1999, 27:617–621.

    Article  PubMed  CAS  Google Scholar 

  16. Tuhrim S, Dambrosia JM, Price TR, et al.: Prediction of intracerebral hemorrhage survival. Ann Neurol 1988, 24:258–263.

    Article  PubMed  CAS  Google Scholar 

  17. Hemphill JC 3rd, Bonovich DC, Besmertis L, et al.: The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001, 32:891–897.

    PubMed  Google Scholar 

  18. Broderick JP, Brott TG, Duldner JE, et al.: Volume of intracerebral hemorrhage a powerful easy to use predictor of 30-day mortality. Stroke 1993, 24:987–993.

    PubMed  CAS  Google Scholar 

  19. Zurasky JA, Aiyagari V, Zazulia AR, et al.: Early mortality following spontaneous intracerebral hemorrhage. Neurology 2005, 64:725–727.

    PubMed  CAS  Google Scholar 

  20. Bagley C: Blood in cerebrospinal fluid. Resultant functional and organic alterations in the cent ral nervous system. Arch Surg 1928, 17:39–81.

    Google Scholar 

  21. Ellington E, Margolis G: Block of arachnoid villus by subarachnoid hemorrhage. J Neurosurg 1969, 30:651–657.

    Article  PubMed  CAS  Google Scholar 

  22. Barrett RJ, Hussain R, Coplin WM, et al.: Spontaneous intracerebral hemorrhage Neurocrit Care 2005, 3:1–10.

    Article  Google Scholar 

  23. Diringer MN, Edwards DF, Zazulia AR: Hydrocephalus: a previously unrecognized predictor poor outcome from supratentorial intracerebral hemorrhage. Stroke 1998, 29:1352–1357.

    PubMed  CAS  Google Scholar 

  24. Steinke W, Sacco RL, Mohr JP: Thalamic stroke. Presentation and prognosis of infarcts and hemorrhages. Arch Neurol 1992, 49:703–710.

    PubMed  CAS  Google Scholar 

  25. Mendelow AD, Gregson BA, Fernandes HM, et al.; STICH investigators: Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005, 365:387–397.

    PubMed  Google Scholar 

  26. Montes JM, Wong JH, Fayad PB, Awad IA: Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: protocol and preliminary experience. Stroke 2000, 31:834–840.

    PubMed  CAS  Google Scholar 

  27. Thiex R, Rohde V, Rohde I, et al.: Frame-based and frameless stereotactic hematoma puncture and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral hemorrhage. J Neurol 2004, 251:1443–1450.

    Article  PubMed  Google Scholar 

  28. Vespa P, McArthur D, Miller C, et al.: Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduction of hemorrhage volume and neurological improvement. Neurocrit Care 2005, 2:274–281

    Article  PubMed  Google Scholar 

  29. Naff NJ, Carhuapoma JR, Williams MA, et al.: Treatment of intraventricular hemorrhage with urokinase: effects on 30-day survival. Stroke 2000, 31:841–847.

    PubMed  CAS  Google Scholar 

  30. Naff NJ, Hanley DF, Keyl PM, et al.: Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind controlled trial. Neurosurgey 2004, 54:577–583; discussion 583–584.

    Article  Google Scholar 

  31. Todo T, Usui M, Takakura K: Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. J Neurosurg 1991, 74:81–86.

    PubMed  CAS  Google Scholar 

  32. Coplin WM, Vinas FC, Agris JM, et al.: A cohort study of the safety and feasibility of intraventricular urokinase for nonaneurysmal spontaneous intraventricular hemorrhage. Stroke 1998, 29:1573–1579.

    PubMed  CAS  Google Scholar 

  33. Fountas KN, Kapasalaki EZ, Parish DC, et al.: Intraventricular administration of rt-PA in patients with intraventricular hemorrhage. South Med J 2005, 8:760.

    Google Scholar 

  34. Lapointe M, Haines S: Fibrinolytic therapy for intraventricular hemorrhage in adults. Cochrane Database Syst Rev 2002, 3:CD003692.

  35. Findlay JM, Grace MG, Weir BK: Treatment of intraventricular hemorrhage with tissue plasminogen activator. Neurosurgery 1993, 32:941–947.

    Article  PubMed  CAS  Google Scholar 

  36. Varelas PN, Rickert KL, Cusick J, et al.: Intraventricular hemorrhage after aneurismal subarachnoid hemorrhage: pilot study of treatment with intraventricular tissue plasmonigen activator. Neurosurgery 2005, 56:205–213.

    Article  PubMed  Google Scholar 

  37. Goh KY, Poon WS: Recombinant tissue plasminogen activator for the treatment of spontaneous adult intraventricular hemorrhage. Surg Neurol 1998, 50:526–531.

    Article  PubMed  CAS  Google Scholar 

  38. Paneth N, Pinto-Martin J, Gardiner J, et al.: Incidence and timing of germinal matrix/intraventricular hemorrhage in low birth weight infants. Am J Epidemiol 1993, 137:1167–1176.

    PubMed  CAS  Google Scholar 

  39. Whitelaw A, Pople I, Cherian S, et al.: Phase 1 trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by drainage, irrigation, and fibrinolytic therapy. Pediatrics 2003, 111(4 Pt 1):759–765.

    Article  PubMed  Google Scholar 

  40. Whitelaw A: Intraventricular streptokinase after intraventricular hemorrhage in newborn infants. Cochrane Database Syst Rev 2001, 1.

Download references

Author information

Authors and Affiliations

  1. Division of Neurosciences Critical Care, Johns Hopkins, University School of Medicine, 600 N. Wolfe Street, Meyer 8-138, Baltimore, MD, 21287-7840, USA

    Paul Nyquist

Authors
  1. Paul Nyquist
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shannon LeDroux
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Romergryko Geocadin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Nyquist.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nyquist, P., LeDroux, S. & Geocadin, R. Thrombolytics in intraventricular hemorrhage. Curr Neurol Neurosci Rep 7, 522–528 (2007). https://doi.org/10.1007/s11910-007-0080-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-007-0080-9

Keywords

Search

Navigation