The Safety and Feasibility of Urokinase Thrombolysis for Nonaneurysmal Intraventricular Hemorrhage

Lee, Sang Kook; Hwang, Sung Kyun; Cho, Do Sang; Kim, Sung Hak; Park, Dong Bin

Abstract

OBJECTIVES
The authors report experience with patients harboring nonaneurysmal intraventricular hemorrhage treated urokinase thrombolysis and evaluated safety and feasibility of this procedure.
METHODS
Fifty-three patients with nonaneurysmal IVH >25 ml without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale (GCS)<5 were excluded. A catheter was directed stereotactically into the IVH under CT guidance. Hematoma aspiration was followed by instillation of urokinase. This was repeated every 6 hours until less than half of its initial volume. For analysis of prognostic factors, we classified two groups ; good (Glasgow Outcome Scale (GOS) > or =3) and bad (GOS<3) prognosis group, and performed comparative analysis between two groups.
RESULTS
Mean age was 60.2 years .The baseline hematoma size ranged 16 to 72 ML. IVH volume reduction was done by an average of 74.2%. At 6 months after the procedure, 29 patients had achieved a good recovery, 15 remained vegetative. 9 patients died in hospital. The main good prognostic factors were young age, small IVH volume, high GCS, underlying disease and associated complications.
CONCLUSION
The results of this study suggest that this relatively easy and safe method of treatment will improve the prognosis. However, further clinical studies also must assess optimal thrombolytic dosage, frequency, and timing of urokinase instillation for safety and effectiveness and must include controlled comparisons of mortality, disability outcome, quality of life, time until convalescence, and cost of care in treated and untreated patients.