Science Times: Thrombolytic Removal of Intraventricular Hemorrhage in Treatment of Severe Stroke: Results of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase III Trial

Intracerebral hemorrhage is a devastating cause of morbidity and mortality, affecting between 37 000 and 52 400 patients annually in the United States.1Patients with intraventricular hemorrhage (IVH) extension have a poorer prognosis, with mortality rates greater than 50% and good functional outcomes in less than 20%.2 Furthermore, the calculated volume of intraventricular blood has been shown to predict worse outcome.3 External ventricular drainage (EVD) is the mainstay of neurosurgical management of patients with obstructive hydrocephalus caused by intraventricular blood. Recent studies have aimed to elucidate the role of thrombolysis via the ventricular drain in evacuating IVH, with the goal of improving mortality and functional outcomes.

After encouraging results of studies investigating intraventricular thrombolysis in animal models, randomized, double-blind, placebo-controlled trials testing intraventricular urokinase for thrombolysis in humans with intracerebral hemorrhage showed promising results for reduction in mortality.4,5 Following commercial withdrawal of urokinase from the market, a study analyzing 34 044 patients with nontraumatic intracerebral hemorrhage requiring ventriculostomy in the Nationwide Inpatient Sample, 1133 of whom received intraventricular tissue plasminogen activator, showed reductions in inpatient mortality of 32.4% in those treated vs 41.6% in the control group.6

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