Treatment of intraventricular hemorrhage with recombinant tissue plasminogen activator

Objective To study the clinical efficacy and safety of direct intraventricular administration of recombinant tissue plasminogen activator (rt-PA) in patients with intraventricular hemorrhage (IVH). Methods A series of 10 patients with IVH, admitted to our hospital from November 2005 to October 2007, was studied for the effect of direct intraventricular administration of rt-PA. In all patients, ventriculostomy was performed in unilateral or bilateral ventricles through frontal burr holes as soon as the IVH was diagnosed on CT. Four or 6 h later, 4 to 8 mg rt-PA was slowly injected through the ventricular catheter. The injection was repeated at 12-24 h intervals until serial CT scans showed a substantial reduction of intraventricular blood. CT scan was conducted at 24-48 h after injection of rt-PA. The outcome of patients was evaluated according to Glasgow Outcome Scale (GOS)on day 30 after IVH. Results The total dose of rt-PA per patient ranged from 13 to 24 mg. On day 30after IVH, 4 patients had a good recovery, 3 patients were moderately disabled, 2 were severely disabled,and 1 was in a vegetative state, and no patient died. There were no hemorrhagic and intracranial infectious complications resulted from treatment, and no catheter became obstructed With blood clot.Conclusions Intraventricular administration of rt-PA can speed the resolution of intraventricular blood clot, keep the ventricular drainage catheter open, reduce the space-occupying effect of the blood clot.Intraventricular administration ofrt-PA is effective and safe, and can improve the patients' prognosis. Key words: Intraventricular hemorrhage;  Tissue plasminogen activator;  Injections,intraventricular