Fibrinolytic therapy for intraventricular hemorrhage in adults

There is no evidence available on the effect of clot dissolving drugs for intraventricular hemorrhage. About one-sixth of all acute strokes are due to bleeding in the brain. Sometimes the blood enters the ventricles, the fluid-filled spaces within the brain. This can block the circulation of fluid around the brain, causing rapid neurologic deterioration and even death. Fibrinolytic (or clot dissolving) treatment might help to break up blood clots, promote clearance of blood and reduce the risk of poor outcome. This review was not able to find sufficient good quality evidence from randomized trials to show whether this treatment does more good than harm. This therapy appears promising but further trials are needed to fully assess safety and efficacy.

Authors' conclusions: 

There is anecdotal evidence suggesting that the intraventricular administration of fibrinolytic agents in intraventricular hemorrhage maybe of therapeutic value and safe. Thus far, there are no randomized trials of sufficient size and quality to evaluate the safety and efficacy of this treatment modality.

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Background: 

Spontaneous or secondary intraventricular hemorrhage is a marker of poor prognosis for hemorrhagic stroke. It can cause hydrocephalus and require ventricular shunt placement, result in permanent neurological deficits or death. Fibrinolytic agents injected into the ventricular system could dissolve blood clots, increase the clearance of blood from the ventricles and hence improve outcome.

Objectives: 

To assess the clinical efficacy and safety of thrombolytic agents administered intraventricularly in the management of intraventricular hemorrhage in adults.

Search strategy: 

We searched the Cochrane Stroke Group Trials Register (last searched February 2002). In addition, we searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Current Contents, and International Pharmacy Abstracts to 2001. We handsearched several neurosurgery journals and the references list of articles identified.

Selection criteria: 

Randomized unconfounded studies comparing intraventricular fibrinolytic therapy to placebo or open control for the management of intraventricular hemorrhage in adults.

Data collection and analysis: 

Two reviewers independently assessed all identified trials. Clinically significant information related to patient population, efficacy and safety were extracted and summarized.

Main results: 

A total of 10 studies were identified by our search strategy. Eight of them were excluded because of case series designs or retrospective control group. One quasi-randomized trial used alternate allocation and was excluded. Only one report met the review criteria for randomization. The randomized trial reported good outcome but has important design flaws resulting in a biased control group and therefore was excluded.

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