Intraventricular Fibrinolysis Versus External Ventricular Drainage Alone in Intraventricular Hemorrhage
- 1 October 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 42 (10), 2776-2781
- https://doi.org/10.1161/strokeaha.111.615724
Abstract
Background and Purpose—: 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.This publication has 29 references indexed in Scilit:
- Intraventricular Tissue Plasminogen Activator for the Prevention of Vasospasm and Hydrocephalus After Aneurysmal Subarachnoid HemorrhageNeurosurgery, 2010
- Exacerbation of Perihematomal Edema and Sterile Meningitis With Intraventricular Administration of Tissue Plasminogen Activator in Patients With Intracerebral HemorrhageNeurosurgery, 2010
- Intracerebral haemorrhageThe Lancet, 2009
- Intraventricular HemorrhageStroke, 2009
- Frequency of Sustained Intracranial Pressure Elevation during Treatment of Severe Intraventricular HemorrhageCerebrovascular Diseases, 2009
- Intracerebral Hemorrhage With Severe Ventricular InvolvementStroke, 2007
- Intraventricular recombinant tissue plasminogen activator for lysis of intraventricular haemorrhage.Journal of Neurology, Neurosurgery & Psychiatry, 1995
- Treatment of Intraventricular Hemorrhage with Tissue Plasminogen ActivatorNeurosurgery, 1993
- Treatment of Intraventricular Hemorrhage Using UrokinaseNeurologia medico-chirurgica, 1990
- Beta blockade during and after myocardial infarction: An overview of the randomized trialsProgress in Cardiovascular Diseases, 1985