Intraventricular Thrombolysis Speeds Blood Clot Resolution: Results of a Pilot, Prospective, Randomized, Double-blind, Controlled Trial

Author:

Naff Neal J.1,Hanley Daniel F.2,Keyl Penelope M.3,Tuhrim Stanley4,Kraut Michael5,Bederson Joshua6,Bullock Ross7,Mayer Stephan A.8,Schmutzhard Eric9

Affiliation:

1. Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland

2. Department of Neurology, The Johns Hopkins Medical Institutions, Baltimore, Maryland

3. Department of Emergency Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland

4. Department of Neurology, Mt. Sinai Hospital, New York, New York

5. Department of Neuroradiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland

6. Department of Neurosurgery, Mt. Sinai Hospital, New York, New York

7. Department of Neurosurgery, Medical College of Virginia, Richmond, Virginia

8. Department of Neurology, Columbia-Presbyterian Medical Center, New York, New York

9. Department of Neurology, University Hospital, Innsbruck, Austria

Abstract

Abstract OBJECTIVE Animal models and clinical studies suggest that intraventricular thrombolysis improves clot resolution and clinical outcomes among patients with intraventricular hemorrhage. However, this intervention may increase the rates of rebleeding and infection. To assess the safety and efficacy of intraventricular thrombolysis, we conducted a pilot, randomized, double-blind, controlled, multicenter study. METHODS Patients with intraventricular hemorrhage requiring ventriculostomy were randomized to receive intraventricular injections of normal saline solution or urokinase (25,000 international units) at 12-hour intervals. Injections continued until ventricular drainage was discontinued according to prespecified clinical criteria. Head computed tomographic scans were obtained daily, for quantitative determinations of intraventricular hemorrhage volumes. The rate of clot resolution was estimated for each group. RESULTS Twelve subjects were enrolled (urokinase, seven patients; placebo, five patients). Commercial withdrawal of urokinase precluded additional enrollment. The urokinase and placebo groups were similar with respect to age (49.6 versus 55.2 yr, P = 0.43) and presenting Glasgow Coma Scale scores (7.14 versus 8.00, P = 0.72). Randomization to the urokinase treatment arm (P = 0.02) and female sex (P = 0.008) favorably affected the clot resolution rate. The sex-adjusted clot half-life for the urokinase-treated group was reduced 44.6%, compared with the value for the placebo group (4.69 versus 8.48 d). CONCLUSION Intraventricular thrombolysis with urokinase speeds the resolution of intraventricular blood clots, compared with treatment with ventricular drainage alone.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

Reference32 articles.

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