Treatment of intraventricular hemorrhage with intraventricular administration of recombinant tissue plasminogen activator: A clinical study of 18 cases

Objective Intraventricular hemorrhage is associated with a very poor outcome. Simple external ventricular drainage alone has not resulted in a decline of mortality. The aim was to study the effect of direct intraventricular administration of recombinant tissue plasminogen activator (rtPA). Patients and methods A retrospective series of eighteen adult patients with severe intraventricular hemorrhage, admitted to our university hospital, was studied for the effect of direct intraventricular administration of recombinant tissue plasminogen activator (rtPA). rtPA was administered in a dosage of 2 mg. The injection was repeated at 12 h intervals until serial CT scans showed a substantial reduction of intraventricular blood. Results The total of rtPA doses per patient ranged from 2 to 32 mg. Seven out of 18 patients showed good neurological recovery, 4 died. Only one patient had a complication which could be directly attributed to the intraventricular thrombolytic therapy. Conclusion We conclude that the procedure of intraventricular administration of a thrombolytic agent, i.e. rtPA, seems effective in lysis of the intraventricular hematoma and may, therefore, improve outcome.