Low-Dose Recombinant Tissue-Type Plasminogen Activator Enhances Clot Resolution in Brain Hemorrhage

Abstract

Background and Purpose Patients with intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) have a reported mortality of 50–80%. We evaluated a clot lytic treatment strategy for these patients in terms of mortality, ventricular infection, and bleeding safety events and for its effect on the rate of intraventricular clot lysis. Methods 48 Patients were enrolled at 14 centers and randomized to treatment with 3mg recombinant tissue plasminogen activator (rt-PA) or placebo. Demographic characteristics, severity factors, safety outcomes (mortality, infection, bleeding), and clot resolution rates were compared in the two groups. Results Severity factors, including admission GCS, ICH volume, IVH volume and blood pressure, were evenly distributed, as were adverse events except for an increased frequency of respiratory system events in the placebo-treated group. Neither ICP nor Cerebral Perfusion pressure (CPP) differed substantially between treatment groups on presentation, with EVD closure, or during the active treatment phase. Frequency of death and ventriculitis was substantially lower than expected and bleeding events remained below the pre-specified threshold: mortality (18%, rt-PA; 23%, placebo); ventriculitis (8%, rt-PA; 9%, placebo); symptomatic bleeding (23%, rt-PA; 5% placebo, which approached statistical significance (p=0.1)). The median duration of dosing was 7.5 days for rt-PA and 12 days for placebo. There was a significant beneficial effect of rt-PA on rate of clot resolution Conclusions Low-dose rt-PA for the treatment of ICH with IVH has an acceptable safety profile compared to placebo and prior historical controls. Data from a well-designed Phase III clinical trial, such as CLEAR III, will be needed to fully evaluate this treatment. Clinical Trial Registration Information Participant enrollment began prior to July 1, 2005.

Minimally Invasive Surgery for Intracerebral and Intraventricular Hemorrhage

“…The pharmacologically based mechanisms involve the administration of lytic medications (urokinase or tPA) through conventional indwelling EVDs which have been placed for the management of the initial hemorrhage. 40 The mechanically based mechanisms involve the direct evacuation of IVH under endoscopic visualization, either using the endoscope itself or an adjunctive device. 26 In most IVH patients, the placement of an EVD represents standard treatment, for this reason, the administration of a lytic agent through an in situ catheter represents a minimal extension of the standard care already being delivered.…”

Risk factors for hydrocephalus requiring external ventricular drainage in patients with intraventricular hemorrhage

“…1,3,5,6,8,10,14,17,19,22,23,25,26 No previous study has directly investigated IVH and hydrocephalus regarding hemorrhage location and volume, although a few have made observations while examining other primary outcomes.…”

Mažos Trepanacijos (Minitrepanacijos) Metodika Šalinant Galvos Smegenų Hemoraginį Insultą. Klinikinis Atvejis Ir Metodikos Aprašymas

“…Šis metodas nesėkmingai nutraukiamas tuo atveju, jeigu: 1) hematoma nepašalinta suleidus iki 12 trombolitiko dozių, 2) būna pakraujavimas, infekcija ar mirtis [27,28]. Nors kai kurie autoriai rodo labai gerus šio metodo rezultatus palyginus su kitais gydymo metodais [29], tačiau dauguma autorių sutinka, kad šis metodas turi daug trūkumų [25,29].…”