Alteplase (rtPA) treatment of intraventricular hematoma (IVH): safety of an efficient methodological approach for rapid clot removal

Intraventricular hemorrhage (IVH) subsequent to intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) is associated with high mortality and morbidity. The use of fibrinolytic agents to treat this condition has previously been reported in small clinical trials with limited numbers of patients. Variability regarding inclusion criteria, method of administration and outcome have made it difficult to draw firm conclusions regarding the efficacy of antifibrinolytic therapy. Nine patients with CT-diagnosed IVH were treated with Alteplase intrathecally for 3 to 5 days according to the CT-verified clearance of IVH. After the treatment period, a repeat CT scan was performed to evaluate treatment effect.In this safety study, we achieved rapid removal of IVH compared to retrospective controls, without incidents of re-bleeding, with only 33% permanent shunt placements and a neurological outcome of GOS of 4-5 in 44% of the patients. Based on the above results, the treatment protocol was considered safe and highly effective. A prospective randomized national multicenter trial has been initiated in order to evaluate the efficacy of this novel method also in terms of outcome and shunt dependency.