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(Stroke. 2000;31:841.)
© 2000 American Heart Association, Inc.

Original Contributions

Treatment of Intraventricular Hemorrhage With Urokinase

Effects on 30-Day Survival

Neal J. Naff, MD; Juan R. Carhuapoma, MD; Michael A. Williams, MD; Anish Bhardwaj, MD; John A. Ulatowski, MD, PhD; Joshua Bederson, MD; Ross Bullock, MD; Erich Schmutzhard, MD; Bettina Pfausler, MD; Penelope M. Keyl, PhD; Stanley Tuhrim, MD Daniel F. Hanley, MD

From the Division of Neurosurgery, Walter Reed Army Medical Center (N.J.N.), Washington, DC; Neurosciences Critical Care Division (J.R.C., M.A.W., A.B., J.A.U., D.F.H.) and Department of Emergency Medicine (P.M.K.), The Johns Hopkins Medical Institutions, Baltimore, Md; Departments of Neurosurgery and Neurology (J.B., S.T.), Mount Sinai Medical Center, New York, NY; Department of Neurological Surgery (R.B.), Medical College of Virginia, Richmond; and Department of Neurology (E.S., B.P.), University Hospital, Innsbruck, Austria.

Correspondence to Daniel F. Hanley, MD, Division of Neurosciences Critical Care, Meyer 8-140, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287-7840. E-mail: dhanley{at}jhmi.edu

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.

Key Words: intraventricular hemorrhage • outcome • urokinase

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