Department of Neurology, University of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
Stroke. 2011 Jul;42(7):2061-4. doi: 10.1161/STROKEAHA.110.608190. Epub 2011 May 5.
The aim of the current study was to investigate the dose-dependent efficacy of intraventricular fibrinolysis (IVF) in patients with severe intraventricular hemorrhage (IVH).
Patients with intracerebral hemorrhage, severe IVH, and obstructive hydrocephalus with the need for external ventricular drainage were treated with IVF through external ventricular drainage. The time course of IVH resolution and the safety profile were compared between patients treated with high-dose IVF (4 mg alteplase every 12 hours, maximum 20 mg; n=32) and low-dose IVF (1 mg alteplase every 8 hours, maximum 12 mg; n=22). CT scans on Days 1 to 4, 7 ± 1 and 10 ± 1 after admission, were analyzed volumetrically. Outcome was assessed after 3 months.
The overall effect of IVF dosage was not significantly different between the 2 groups (F=1.3, P=0.25). The course of IVH volume in the third and fourth ventricles was similar with high- and low-dose IVF. High-dose IVF resulted in lower total IVH volumes on Days 7 (4.4 ± 4.2 mL versus 8.8 ± 8.1 mL; P=0.01) and 10 (1.4 ± 2.8 mL versus 4.9 ± 65.8 mL; P=0.005). Total clot half-life was 78 ± 43 hours in the low-dose and 56 ± 25 hours in the high-dose group (P=0.02). One asymptomatic ventricular bleeding, 2 cases of ventriculitis, and 1 death due to pulmonary embolism occurred in the high-dose group. There was no difference in outcome at 3 months.
Low-dose IVF (3 mg alteplase/day) has a similar effect on IVH clearance from the third and fourth ventricles and a similar safety profile when compared with high-dose IVF (8 mg alteplase/day).
本研究旨在探讨脑室内纤维蛋白溶解（IVF）治疗严重脑室内出血（IVH）的剂量依赖性疗效。
对因脑出血、严重 IVH 且需要行外引流的梗阻性脑积水患者进行 IVF 治疗，通过外引流进行。对比高剂量 IVF（4 mg 阿替普酶，每 12 小时 1 次，最大 20 mg；n=32）和低剂量 IVF（1 mg 阿替普酶，每 8 小时 1 次，最大 12 mg；n=22）治疗的患者，IVH 缓解的时间过程和安全性概况。在入院第 1 天至第 4 天、第 7 ± 1 天和第 10 ± 1 天进行 CT 扫描，进行容量分析。在 3 个月后进行预后评估。
2 组患者 IVF 剂量的总体效果无显著差异（F=1.3，P=0.25）。高、低剂量 IVF 组第三和第四脑室的 IVH 体积进程相似。高剂量 IVF 使第 7 天（4.4 ± 4.2 mL 与 8.8 ± 8.1 mL；P=0.01）和第 10 天（1.4 ± 2.8 mL 与 4.9 ± 65.8 mL；P=0.005）的总 IVH 体积更小。低剂量组的总凝块半衰期为 78 ± 43 小时，高剂量组为 56 ± 25 小时（P=0.02）。高剂量组发生 1 例无症状性脑室出血、2 例脑室炎和 1 例因肺栓塞死亡。3 个月时的预后无差异。
与高剂量 IVF（8 mg 阿替普酶/天）相比，低剂量 IVF（3 mg 阿替普酶/天）对第三和第四脑室 IVH 清除的效果相似，安全性相似。
