Abstract Details

Title Intraventricular Fibrinolysis in Patients with Intraventricular Hemorrhage

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P05 - (-)

Poster/Presentation
Number 200

Objective

Background BACKGROUND: Intraventricular fibrinolysis has been shown effective in clearing intraventricular hemorrhage (IVH) in small series of patients.

Design/Methods DESIGN/METHODS: Retrospective analysis of prospectively collected data of patients admitted with IVH and treated with rt-PA instillation via intraventricular catheter (IVC) until clearance of the 3rd and 4th ventricles. The Graeb and LeRoux semiquantitative scales were used to measure the amount of IVH before and after the last dose.

Results RESULTS: 55 patients (mean age 58.6 years, 58.2% male) had the following admission diagnoses: 30 intracerebral and 17 aneurysmal subarachnoid hemorrhage, 4 brain tumors, 1 head trauma, 1 arteriovenous malformation, 1 primary IVH and 1 post IVC placement. rt-PA was administered at a total dose of 5.1±4.7mg (individual doses ranging between 0.5 to 4 mg). The pre-fibrinolysis Graeb and LeRoux scores of 8.1±1.8 and 11.3±2.5,decreased post fibrinolysis to 4.6±1.8 and 5.3±2.6 (p<0.001). A significant correlation between total fibrinolytic dose and difference in pre-post amount of IVH was found for the LeRoux scale (Pearson 0.413, p < 0.002). Three patients had small tract bleeds and one extension of ICH in the upper midbrain. No patient developed ventriculitis. The total dose of rt-PA was lower in 11 shunted patients, compared to 44 who did not (3.3±2.5 vs 5.6±5, p<0.039). A higher percentage change of blood pre-post rt-PA was associated with better outcomes by Glasgow Outcome Scale (GOS). After adjustments, post rt-PA Graeb score was associated with good GOS outcome and diagnosis with shunt placement.

Conclusions CONCLUSIONS: In our large series, intraventricular fibrinolysis entailed minimal complications. The higher the total dose of rt-PA, the less the blood remaining inside the ventricles and the more ventricular blood removed, the better the outcome.

Authors/Disclosures
Panayiotis N. Varelas, MD, PhD, FAAN (Albany Med-Department of Neurology) PRESENTER	Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Astra Zeneca -Alexion - Portola. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Annexon. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca- Alexion-Portola. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Annexon. Dr. Varelas has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Giammarco, Mullins & Horton P.C. The institution of Dr. Varelas has received research support from Marinus. The institution of Dr. Varelas has received research support from Bayer. Dr. Varelas has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Rep to the RUC meeting with AAN. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving as a Speaker at the Annual Meeting with AAN. Dr. Varelas has a non-compensated relationship as a President - Past President with Neurocritical Care Society that is relevant to AAN interests or activities.
	No disclosure on file
Gavin Giovannoni, MD (QMUL)	Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck KGaA. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche-Genentech. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Moderna. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Astoria Biologica. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zenas. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medscape.
Tamer Abdelhak, MD (Albany Medical College)	Dr. Abdelhak has nothing to disclose.
Marianna V. Spanaki-Varelas, MD, PhD (Albany Medical College)	Dr. Spanaki-Varelas has received personal compensation in the range of $500-$4,999 for serving as a RUC ADVISOR with AAN .
Kristin Kahle-Wrobleski	No disclosure on file
Ann Helms, MD (Medical College of WI)	Dr. Helms has nothing to disclose.

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