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Abstract

Background

Intraventricular hemorrhage is a significant cause of mortality and morbidity worldwide. Treating intraventricular hemorrhage with intraventricular fibrinolytic therapy via a catheter is becoming an increasingly utilized intervention.

Aims

This meta-analysis aimed to investigate the role of intraventricular fibrinolytic treatment in hypertensive intraventricular hemorrhage patients and evaluate the effect sizes for survival as well as level of function at differing time points.

Summary of review

PubMed, CNKI, VIP, and Wanfang were searched using the terms “IVH” and “IVH and ICH” for human studies with adult patients published between January 1950 and July 2016. Seventeen publications were selected. Data analysis showed lower rates of mortality in the treatment group at 30 days (P < 0.001), 180 days (P = 0.001), 365 days (P = 0.40), and overall (P < 0.001). Pooling modified Rankin Scale and Glasgow outcome scale data, the treatment group had more good functional outcomes at 30 days (P = 0.38), 90 days (P = 0.04), 180 days (P = 0.31), 365 days (P = 0.76), and overall (P = 0.02). Good functional outcome was defined as modified Rankin Scale score of 0 to 3 or a Glasgow outcome scale score of 3 to 5.

Conclusions

Intraventricular fibrinolytic for treatment of hypertensive intraventricular hemorrhage reduces mortality and potentially leads to an increased number of good functional outcomes. Different functional outcome scales (modified Rankin Scale or Glasgow outcome scale) produce different effect sizes. Intraventricular fibrinolytic treatment may offer intraventricular hemorrhage patients a targeted therapy that produces meaningful mortality benefit and possible functional outcome benefits.

Keywords

Intraventricular hemorrhage intraventricular fibrinolytic alteplase modified Rankin Scale Glasgow Outcome Scale functional outcome mortality

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References

Lee

Park

Kang

Park

Chung

. Factors associated with clinical outcomes in patients with primary intraventricular hemorrhage. Med Sci Moni: Int Med J Exp Clin Res 2017; 23: 1401–1412.

Guo

Shrestha

You

. A retrospective clinical study of 98 adult idiopathic primary intraventricular hemorrhage cases. Medicine 2016; 95: e5089.

El-Saadany

Hassan

. Adult intraventricular hemorrhage: presentations, management, and analysis of outcome. Neurosurg Quart 2012; 22: 30–37.

Hinson

Hanley

Ziai

. Management of intraventricular hemorrhage. Curr Neurol Neurosci Rep 2010; 10: 73–82.

Sato

Delcourt

Heeley

et al.

Significance of cerebral small-vessel disease in acute intracerebral hemorrhage. Stroke 2016; 47: 701–707.

Dunatov

Antoncic

Bralic

Jurjevic

. Intraventricular thrombolysis with rt-PA in patients with intraventricular hemorrhage. Acta Neurologica Scandinavica 2011; 124: 343–348.

Hanley

Lane

McBee

et al.

Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial. Lancet 2017; 389: 603–611.

Ziai

Moullaali

Nekoovaght-Tak

et al.

No exacerbation of perihematomal edema with intraventricular tissue plasminogen activator in patients with spontaneous intraventricular hemorrhage. Neurocrit Care 2013; 18: 354–361.

Huttner

Tognoni

Bardutzky

et al.

Influence of intraventricular fibrinolytic therapy with rt-PA on the long-term outcome of treated patients with spontaneous basal ganglia hemorrhage: a case–control study. Eur J Neurol 2008; 15: 342–349.

10.

Khan

Tsivgoulis

Lee

et al.

Fibrinolysis for intraventricular hemorrhage. Stroke 2014; 45: 2662–2669.

11.

Volbers

Wagner

Willfarth

Doerfler

Schwab

Staykov

. Intraventricular fibrinolysis does not increase perihemorrhagic edema after intracerebral hemorrhage. Stroke 2013; 44: 362–366.

12.

Gaberel

Magheru

Parienti

J-J

Huttner

Vivien

Emery

. Intraventricular fibrinolysis versus external ventricular drainage alone in intraventricular hemorrhage. Stroke 2011; 42: 2776–2781.

13.

Naff

Williams

Keyl

et al.

Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke 2011; 42: 3009–3016.

14.

Dey

Stadnik

Awad

. Spontaneous intracerebral and intraventricular hemorrhage: advances in minimally invasive surgery and thrombolytic evacuation, and lessons learned in recent trials. Neurosurgery 2014; 74: S142–S150.

15.

Todo

Usui

Takakura

. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. J Neurosurg 1991; 74: 81–86.

16.

Rainov

Burkert

. Urokinase infusion for severe intraventricular haemorrhage. Acta Neurochirurgica 1995; 134: 55–59.

17.

Akdemir

Selcuklu

Pasaoglu

. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. Neurosurg Rev 1995; 18: 95–100.

18.

Halpern S and Douglas JM. Jadad scale for reporting randomized controlled trials. In: Halpern SH and Joanne Douglas M (eds) Evidence-based obstetric anesthesia. John Wiley & Sons, 2005, pp. 237–298.

19.

Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. Ottawa, Ontario: The Ottawa Health Research Institute, 2011.

20.

DerSimonian

Laird

. Meta-analysis in clinical trials revisited. Contemp Clin Trials 2015; 45: 139–145.

21.

Begg

Mazumdar

. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088–1101.

22.

Egger

Davey Smith

Schneider

Minder

. Bias in meta-analysis detected by a simple, graphical test. Biolog Med J 1997; 315: 629–634.

23.

Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, http://handbook.cochrane.org/ (published March 2011; accessed 23 August 2016).

24.

Coplin

Vinas

Agris

et al.

A cohort study of the safety and feasibility of intraventricular urokinase for nonaneurysmal spontaneous intraventricular hemorrhage. Stroke 1998; 29: 1573–1579.

25.

Tung

MYY

Ong

Seow

Tan

. A study on the efficacy of intraventricular urokinase in the treatment of intraventricular hemorrhage. Brit J Neurosurg 1998; 12: 234–239.

26.

Naff

Hanley

Keyl

et al.

Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, perspective, randomized, double-blind controlled trial. Neurosurgery 2004; 54: 577–584.

27.

Gubucz

Kakuk

Major

et al.

Effectiveness and safety of intraventricular fibrinolysis in secondary intraventricular hemorrhages (a prospective, randomized study). Orvosi hetilap 2004; 145: 1609–1615.

28.

Torres

Plans

Martino

et al.

Fibrinolytic therapy in spontaneous intraventricular haemorrhage: efficacy and safety of the treatment. Brit J Neurosurg 2008; 22: 269–274.

29.

Ducruet

Hickman

Zacharia

et al.

Exacerbation of perihematomal edema and sterile meningitis with intraventricular administration of tissue plasminogen activator in patients with intracerebral hemorrhage. Neurosurgery 2010; 66: 648–655.

30.

Hallevi

Walker

Kasam

Bornstein

Grotta

Savitz

. Inflammatory response to intraventricular hemorrhage: time course, magnitude and effect of t-PA. J Neurolog Sci 2012; 315: 93–95.

31.

King

Lai

Tan

et al.

A randomized, placebo-controlled pilot study of patients with spontaneous intraventricular haemorrhage treated with intraventricular thrombolysis. J Clin Neurosci 2012; 19: 961–964.

32.

Sulter

Steen

de Keyser

. Use of the Barthel index and modified Rankin Scale in acute stroke trials. Stroke 1999; 30: 1538–1541.

33.

Jennett

Bond

. Assessment of outcome after severe brain damage: a practical scale. The Lancet 1975; 305: 480–484.

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Fibrinolytic for treatment of intraventricular hemorrhage: A meta-analysis and systematic review

Abstract

Background

Aims

Summary of review

Conclusions

Keywords

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References

Supplementary Material