Fibrinolytics and Intraventricular Hemorrhage: A Systematic Review and Meta-analysis

Abstract

Intraventricular hemorrhage (IVH) is an independent poor prognostic factor in subarachnoid and intra-parenchymal hemorrhage. The use of intraventricular fibrinolytics (IVF) has long been debated, and its exact effects on outcomes are unknown. A systematic review and meta-analysis were performed in accordance with the PRISMA guidelines to assess the impact of IVF after non-traumatic IVH on mortality, functional outcome, intracranial bleeding, ventriculitis, time until clearance of third and fourth ventricles, obstruction of external ventricular drains (EVD), and shunt dependency. Nineteen studies were included in the meta-analysis, totaling 1020 patients. IVF was associated with lower mortality (relative risk [RR] 0.58; 95% confidence interval [CI] 0.47-0.72), fewer EVD obstructions (RR 0.41; 95% CI 0.22-0.74), and a shorter time until clearance of the ventricles (median difference [MD] − 4.05 days; 95% CI − 5.52 to − 2.57). There was no difference in good functional outcome, RR 1.41 (95% CI 0.98-2.03), or shunt dependency, RR 0.93 (95% CI 0.70-1.22). Correction for publication bias predicted an increased risk of intracranial bleeding, RR 1.67 (95% CI 1.01-2.74) and a lower risk of ventriculitis, RR 0.68 (95% CI 0.45-1.03) in IVH patients treated with IVF. IVF was associated with improved survival, faster clearance of blood from the ventricles and fewer drain obstructions, but further research is warranted to elucidate the effects on ventriculitis, long-term functional outcomes, and re-hemorrhage.

The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

“…An analysis of gene expression profiles in human peripheral blood samples indicates that the lymphocyte response is depressed and monocyte activity is enhanced following aSAH [ 94 ]. aSAH induces an early intracerebral infiltration and peripheral activation of innate immune cells [ 92 , 95 ]. Furthermore, microglia and astrocytic activation are present one week following aSAH [ 92 ].…”

Application of magnetically actuated self-clearing catheter for rapid in situ blood clot clearance in hemorrhagic stroke treatment

“…To facilitate blood clot removal, thrombolytic agents are used in conjunction with a drainage device for increased clot resolution 12 . However, using fibrinolytic agents on hemorrhagic patients is a controversial topic due to the elevated risk of additional bleeding and their unknown long-term effects 7 , 13 .…”

Magnetically actuated self-clearing catheter for rapid in situ blood clot clearance for improved hemorrhagic stroke treatment

“…To facilitate the blood clot removal, thrombolytic agents are sometimes used with a drainage device for increased clot resolution 10 . However, using fibrinolytic agents on hemorrhagic patients is a highly controversial topic due to the elevated risk of additional bleeding and their unknown long-term effects 11,12 .…”

“…However, flushing alone is often ineffective in clearing the hematoma, which leads to several replacements of failed drainage devices that also increase the risk of infection and other complications including ventriculitis [15][16][17] . The high obstruction rate of these critical medical devices results in significant complications when treating IVH, PHH, and other applications where indwelling catheters are needed 12 .…”