Low-Dose rtPA May Help IVH Patients

Eleanor McDermid, MedWire News

Thrombolytic therapy to remove blood clots is feasible in patients with intracerebral hemorrhage (ICH) and intraventricular bleeding, shows a preliminary study.

The trial included 48 ICH patients with intraventricular hemorrhage (IVH) from 14 centers who were randomly assigned to treatment with recombinant tissue plasminogen activator (rtPA) 3 mg or placebo (saline) administered into the intraventricular space once every 12 hours. Treatment continued until the opening of at least the third and fourth ventricles or until a safety endpoint occurred (symptomatic bleeding, infection or death).

Patients with IVH have a high mortality rate, and the predicted 30-day mortality rate was about 75 percent for both groups. But actual mortality was lower than expected, at 19 percent of the rtPA group and 23 percent  of the placebo group. Nine of the 10 deaths were attributed to the initial hemorrhage.

Ventriculitis occurred in 8 percent and 9 percent of the rtPA and placebo groups, respectively, but symptomatic bleeding occurred in 23 percent of the rtPA group, compared with just 5 percent of the placebo group, although this did not attain statistical significance.

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