A meta-analysis, published in the journal Stroke, found that intraventricular fibrinolysis (IVF) therapy for acute hydrocephalus caused by intracerebral and intraventricular hemorrhage associated with significantly improved functional and mortality outcomes at 6 months compared with standard care.

A collaboration of investigators from Germany searched publication databases through July 30, 2019, for studies of IVF compared with standard care or placebo for patients receiving external ventricular drainage due to intracerebral hemorrhage (ICH)- or intraventricular hemorrhage (IVH)-associated acute hydrocephalus. The investigators used an individual participant data pooled meta-analysis approach to evaluate functional disability, all-cause mortality, and adverse events.

Nine datasets were pooled for a final sample size of 596 patients who received IVF and 905 who received standard care or placebo. The IVF and control groups were aged mean 61.0±12.4 and 61.6±12.9 years; 41.3% and 39.6% were women; median ICH volume was 8.5 (IQR, 3.1-17.8) and 14.5 (IQR, 5.3-33.5) cm3; 19.5% and 26.0% used prior oral anticoagulation; and 25.0% and 31.0% were in the highest tertile of the Glasgow Coma Scale, respectively.


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Patients with IVF received treatment at a median 47.8 (IQR, 31.0-64.5) hours after symptom onset.

More favorable functional outcomes at 6 months, according to the modified Rankin Scale, were associated with IVF (odds ratio [OR], 1.75; 95% CI, 1.39-2.17; P <.001). Similarly, IVF associated with decreased mortality (adjusted OR [aOR], 0.47; 95% CI, 0.35-0.64; P <.001).

Adverse events occurred among 14.9% of IVF and 13.5% of usual care recipients (adjusted absolute difference [aAD], 1.0%; 95% CI, -2.7% to 4.8%) and new intracranial hemorrhagic complications occurred among 8.6% and 6.0% (aAD, 0.8%; 95% CI, -2.3% to 3.0%), respectively.

Significant absolute treatment effects of IVF were observed among younger patients, those with lower Glasgow Comma Score, non-deep ICH, non-thalamic ICH, larger ICH volumes, moderate IVH volumes, and patients treated in the earliest time window.

The major limitation of this analysis was that all but 2 studies were of observational designs and not controlled trials.

“…the administration of IVF in patients with intracerebral and intraventricular hemorrhage was significantly associated with improved functional outcome at 6 months,” the study authors wrote.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Kuramatsu JB, Gerner ST, Ziai W, et al. Association of intraventricular fibrinolysis with clinical outcomes in ICH: an individual participant data meta-analysis. Stroke. Published online May 6, 2022. doi:10.1161/STROKEAHA.121.038455