A 10-year Retrospective Clinical Analysis of the use of Alteplase in Intraventricular Hemorrhage

Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) is a severe condition where intraventricular extension (in 30 to 40% of patients) has been associated with poorer outcomes. The usefulness of thrombolytic agents to hasten clot dissolution remains under evaluation. Our goal was to assess and report the results of a ten-year experience employing a standardized protocol concerning intraventricular alteplase in patients with intraventricular hemorrhage (IVH), at the Neurocritical Care Unit of a tertiary care hospital. Methods: The primary aim was to analyze the safety profile of alteplase intraventricular administration and its efficiency in clearing the third and fourth ventricles' hemorrhagic components. Secondary endpoints were the incidence of ventriculitis, re-bleeding and need for ventricular shunt placement. The functional outcomes at 30 and 180 days after ictus were measured with Modified Rankin Scale (mRankin). Results: A total of 58 patients were treated with intraventricular alteplase, between January 2013 and June 2022. After its administration, opening of third and fourth ventricles occurred in 84,5% of patients and IVH area was reduced an average of 11,8±12,89%. Re-bleeding after alteplase occurred in one patient (1,7%), ventriculitis in 22,4% and the need for a ventriculoperitoneal shunt in 17,2%. A mRankin score ≤ 3 was observed in 3,4% and 10,3% and a mRankin of 6 in 24,1% and 39,7% of patients, respectively at 30 and 180 days. Conclusions: Our field-tested protocol of ten years in the acute phase attests to the safety and efficacy of an intraventricular fibrinolytic for third and fourth ventricle opening and IVH reduction.