Effectiveness of Combined External Ventricular Drainage with Intraventricular Fibrinolysis for the Treatment of Intraventricular Haemorrhage with Acute Obstructive Hydrocephalus

Cerebrovasc Dis Extra. 2019;9(2):77-89. doi: 10.1159/000501530. Epub 2019 Aug 13.

Abstract

Background: Intraventricular haemorrhage (IVH) patients with acute obstructive hydrocephalus (AOH) who require external ventricular drainage (EVD) are at high risk for poor outcomes. Intraventricular fibrinolysis (IVF) with low-dose recombinant tissue plasminogen activator (rtPA) can be used to improve patient outcomes. Here, we evaluated the impact of IVF on the risk of death and the functional outcomes in IVH patients with AOH.

Methods: This prospective cohort study included IVH patients with hypertensive intracranial haemorrhage complicated by AOH who required EVD. We evaluated the risk of death and the functional outcomes at 1 and 3 months, with a specific focus on the impact of combined EVD with IVF by low-dose rtPA.

Results: Between November 30, 2011 and December 30, 2014, 80 patients were included. Forty-five patients were treated with EVD alone (EVD group) and 35 received IVF (EVD+IVF group). The 30- and 90-day mortality rates were lower in the EVD+IVF group than in the EVD group (42.2 vs. 11.4%, p = 0.003, and 62.2 vs. 20%, p < 0.001, respectively). The Graeb scores were significantly lower in the EVD+IVF group than in the EVD group (p ≤ 0.001) during the first 3 days and on day 7 after assignment. The 30-day good functional outcome (modified Rankin Scale [mRS] score 0-3) was also higher in the EVD+IVF group than in the EVD group (6.7 vs. 28.6%, p = 0.008). However, the 90-day good functional outcome (mRS score 0-3) did not significantly increase in the EVD+IVF group (30.8% in the EVD group vs. 51.6% in the EVD+IVF group, p = 0.112).

Conclusions: In our prospective observational study, EVD+IVF was associated with a lower risk of death in IVH patients. EVD+IVF improved the chance of having a good functional outcome at 1 month; however, this result was no longer observed at 3 months.

Keywords: Acute obstructive hydrocephalus; External ventricular drainage; Intracerebral haemorrhage; Intraventricular fibrinolysis; Intraventricular haemorrhage; Recombinant tissue plasminogen activator.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Cerebral Intraventricular Hemorrhage / diagnostic imaging
  • Cerebral Intraventricular Hemorrhage / mortality
  • Cerebral Intraventricular Hemorrhage / physiopathology
  • Cerebral Intraventricular Hemorrhage / therapy*
  • Combined Modality Therapy
  • Drainage / adverse effects
  • Drainage / methods*
  • Drainage / mortality
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Hydrocephalus / diagnostic imaging
  • Hydrocephalus / mortality
  • Hydrocephalus / physiopathology
  • Hydrocephalus / therapy*
  • Male
  • Middle Aged
  • Prospective Studies
  • Recovery of Function
  • Risk Assessment
  • Risk Factors
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / methods*
  • Thrombolytic Therapy / mortality
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator