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 drainage alone has not modified outcome in these patients. Methods - Twelve pilot IVH patients who required external ventricular drainage were prospectively treated with intraventricular urokinase followed by the randomized, double-blinded allocation of 8 patients to either treatment or placebo. Observed 30-day mortality was compared with predicted 30-day mortality obtained by use of a previously validated method. Results - Twenty patients were enrolled; admission Glasgow Coma Scale score in 11 patients was ≤8; 10 patients had pulse pressure <85 mm Hg. Mean±SD ICH volume in 16 patients was 6.21±7.53 cm³ (range 0 to 23.88 cm³), and mean±SD intraventricular hematoma volume was 44.26±31.65 cm³ (range 1.31 to 100.36 cm³). Four patients (20%) died within 30 days. Predicted mortality for these 20 patients was 68.42% (range 3% to 100%). Probability of observing ≤4 deaths among 20 patients under a 68.42% expected mortality is 0.000012. Conclusions - Intraventricular urokinase may significantly improve 30-day survival in IVH patients. On the basis of current evidence, a double-blinded, placebo-controlled, multicenter study that uses thrombolysis to treat IVH has received funding and began January 1, 2000.