Dose Effect of Intraventricular Fibrinolysis in Ventricular Hemorrhage

2,951

1,196

2032Purpose-The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. Methods-A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. Results-Evidence-based guidelines are presented for the care of patients with acute intracerebral hemorrhage. Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. Conclusions-Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted.These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.

Section: Strokementioning

confidence: 99%

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Hemphill¹,

Greenberg²,

Anderson³

et al. 2015

2,951

1,196

“…6 Although not established for SAH, reports on more rapid IVH wash out at higher rt-PA doses were our main impetus to administer higher rt-PA doses during a shorter period of time (4× 5 mg rt-PA >48 hours) because of the necessity of prolonged sedation for concomitant kinetic therapy. 20 However, despite heterogeneous data on the effectiveness and safety in this respect, other studies also suggested lower rt-PA doses until complete blood removal in CT. 17 Nevertheless, the present study is the first randomized trial investigating the effect of intraventricular rt-PA administration to allow the inclusion of patients undergoing either surgical or endovascular repair of ruptured intracranial aneurysm after severe SAH. Despite the higher proportion of conservatively managed subgaleal hematomas in the experimental group, this less invasive and more practical application resulted in safe and highly effective clot reduction, also without altering permanent occlusion of aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Prospective, Randomized, Open-Label Phase II Trial on Concomitant Intraventricular Fibrinolysis and Low-Frequency Rotation After Severe Subarachnoid Hemorrhage

Etminan

Beseoglu

Eicker

et al. 2013

This was a randomized, prospective, open-label, treatment as usualcontrolled phase II study, investigating feasibility, safety, and efficacy. The study was reviewed and approved by the local institutional ethics committee (ID#: 3062) of the Medical Faculty of the Heinrich-HeineUniversity, Düsseldorf, Germany. Sixty patients experiencing aneurys mal SAH, that is, World Association of Neurological Surgeons (WFNS) grade II to V and Fisher grade III to IV, were randomized into experimental or control treatment. 8,9Participants Eligible patients were allocated into the 2 treatment groups in accordance with the randomization sequence after informed consent was obtained. Inclusion criteria were (1) aneurysmal SAH WFNS grade II to V and Fisher grade III to IV; (2) patients aged ˃18 years; (3) admission <24 hours after ictus; (4) no history of anticoagulative or plateletinhibiting drugs; (5) informed consent by a legal representative; and Background and Purpose-The goal of this randomized, open-label phase II study was to investigate the effect of concomitant low-frequency head-motion therapy and intraventricular fibrinolysis in patients after surgical or endovascular treatment for aneurysmal subarachnoid hemorrhage.

“…In this context, faster and more effective drainage of IVH after lysis may be crucial to attenuate inflammatory damage. 23 Of course, in the absence of experimental or histopathologic data, those interpretations remain speculative. Prospective data are necessary to possibly confirm our data and to address further questions such as influence of ventricular rtPA on periventricular matter.…”

Section: Discussionmentioning

confidence: 99%

Intraventricular Fibrinolysis Does Not Increase Perihemorrhagic Edema After Intracerebral Hemorrhage

Volbers

Wagner

Willfarth

et al. 2013

Self Cite

PHE may play a role as a source of additional mass effect, especially in large ICH, and thereby lead to neurological Background and Purpose-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