Effectiveness of Combined External Ventricular Drainage with Intraventricular Fibrinolysis for the Treatment of Intraventricular Haemorrhage with Acute Obstructive Hydrocephalus

• Main Authors: Chinh Quoc Luong, Anh Dat Nguyen, Chi Van Nguyen, Ton Duy Mai, Tuan Anh Nguyen, Son Ngoc Do, Phuong Viet Dao, Hanh Thi My Pham, Dung Thi Pham, Hung Manh Ngo, Quan Huu Nguyen, Dat Tuan Nguyen, Thong Huu Tran, Ky Van Le, Nam Trong Do, Ngoc Duc Ngo, Vinh Duc Nguyen, Hung Duc Ngo, Hai Bui Hoang, Ha Viet Vu, Lan Tuong Vu, Binh Thanh Ngo, Bai Xuan Nguyen, Dai Quoc Khuong, Dung Tien Nguyen, Trung Xuan Vuong, Thu Hong Be, Thomas Gaberel, Lieu Van Nguyen
• Format: Article
• Language: English
• Published: Karger Publishers 2019-08-01
• Series: Cerebrovascular Diseases Extra
• Subjects: Intraventricular haemorrhage; Intracerebral haemorrhage; External ventricular drainage; Acute obstructive hydrocephalus; Intraventricular fibrinolysis; Recombinant tissue plasminogen activator
• Online Access: https://www.karger.com/Article/FullText/501530

Background: Intraventricular haemorrhage (IVH) patients with acute obstructive hydrocephalus (AOH) who require external ventricular drainage (EVD) are at high risk for poor outcomes. Intraventricular fibrinolysis (IVF) with low-dose recombinant tissue plasminogen activator (rtPA) can be used to improve patient outcomes. Here, we evaluated the impact of IVF on the risk of death and the functional outcomes in IVH patients with AOH. Methods: This prospective cohort study included IVH patients with hypertensive intracranial haemorrhage complicated by AOH who required EVD. We evaluated the risk of death and the functional outcomes at 1 and 3 months, with a specific focus on the impact of combined EVD with IVF by low-dose rtPA. Results: Between November 30, 2011 and December 30, 2014, 80 patients were included. Forty-five patients were treated with EVD alone (EVD group) and 35 received IVF (EVD+IVF group). The 30- and 90-day mortality rates were lower in the EVD+IVF group than in the EVD group (42.2 vs. 11.4%, p = 0.003, and 62.2 vs. 20%, p < 0.001, respectively). The Graeb scores were significantly lower in the EVD+IVF group than in the EVD group (p ≤ 0.001) during the first 3 days and on day 7 after assignment. The 30-day good functional outcome (modified Rankin Scale [mRS] score 0–3) was also higher in the EVD+IVF group than in the EVD group (6.7 vs. 28.6%, p = 0.008). However, the 90-day good functional outcome (mRS score 0–3) did not significantly increase in the EVD+IVF group (30.8% in the EVD group vs. 51.6% in the EVD+IVF group, p = 0.112). Conclusions: In our prospective observational study, EVD+IVF was associated with a lower risk of death in IVH patients. EVD+IVF improved the chance of having a good functional outcome at 1 month; however, this result was no longer observed at 3 months.