Treatment of intraventricular hemorrhage with urokinase - Effects on 30-day survival

Background and Purpose-Intraventricular hemorrhage (IVH) remains associated with high morbidity and mortality. Therapy with external ventricular drain age alone has not modified outcome in these patients. Methods-Twelve pilot IVH patients who required external ventricular drainag e were prospectively treated with intraventricular urokinase followed by th e randomized, double-blinded allocation of 8 patients to either treatment o r placebo. Observed 30-day mortality was compared with predicted 30-day mor tality obtained by use of a previously validated method. Results-Twenty patients were enrolled; admission Glasgow Coma Scale score i n 11 patients was less than or equal to 8; 10 patients had pulse pressure < 85 mm Hg. Mean+/-SD ICH volume in 16 patients was 6.21+/-7.53 cm(3) (range 0 to 23.88 cm(3)), and mean+/-SD intraventricular hematoma volume was 44.26 +/-31.65 cm(3) (range 1.31 to 100.36 cm(3)). Four patients (20%) died withi n 30 days. Predicted mortality for these 20 patients was 68.42% (range 3% t o 100%). Probability of observing less than or equal to 4 deaths among 20 p atients under a 68.42% expected mortality is 0.000012. Conclusions-Intraventricular urokinase may significantly improve 30-day sur vival in IVH patients. On the basis of current evidence, a double-blinded, placebo-controlled, multicenter study that uses thrombolysis to treat IVH h as received funding and began January 1, 2000.