Background and Aims

Intraventricular hemorrhage (IVH) is a negative prognostic factor in intracerebral hemorrhage (ICH). In Vietnam, the mortality among IVH patients with acute hydrocephalus requiring external ventricular drainage (EVD) was 57.7%. The aim of our study was to evaluate effectiveness of combined EVD with IVF by low-dose rtPA in IVH patients with acute hydrocephalus.

Method

In this non-randomized controlled study, participants with a routinely placed EVD, in emergency department with stable, ICH volume < 30 ml, and IVH obstructing the 3rd or 4th ventricles were assigned to combined EVD with IVF by low-dose rtPA (1mg every 8 hours, maximum: 9 mg) (intervention) or EVD alone (control).

Results

Between Nov 30, 2011, and Dec 30, 2014, 80 patients were selected: 35 to the interventional and 45 to the control group. Primary outcomes: mortality rates in the control were higher than that in the interventional group at 30 days (42.2% vs. 11.4%, respectively; p < 0.01) and at 90 days (62.2% vs. 20%; respectively, p < 0.01). Secondary outcomes: mRS0-3 at 30 days in the control (6.7%) was lower than that in the interventional group (28.6%) (p < 0.05); and GOS3-5 also improved in the interventional group at 30 days (control: 24.4%; interventional: 74.3%; p < 0.01) and at 90 days (control: 42.3%; interventional: 90.3%; p < 0.01). There were no significant differences in complications between the two groups.

Conclusion

In our study, combined EVD with IVF by low-dose rtPA in IVH patients with acute hydrocephalus improved significantly mortality rates and good functional outcomes comparing with EVD alone.

EFFECTIVENESS OF EXTERNAL VENTRICULAR DRAINAGE IN COMBINATION WITH INTRAVENTRICULAR FIBRINOLYSIS FOR TREATMENT OF INTRAVENTRICULAR HEMORRHAGE WITH ACUTE OBSTRUCTIVE HYDROCEPHALUS