Intraventricular hemorrhage treated with intraventricular fibrinolysis. A 10-year experience.

ABSTRACT

PURPOSE: We evaluate the results and complications of our intraventricular fibrinolysis protocol. MATERIAL AND METHODS: A retrospective analysis was made of the cases of intraventricular hemorrhage with 13-bed Intensive Care Unit. Graeb score 6 or above subjected to intraventricular fibrinolysis. We gathered demographic parameters, clinical risk scores, tomography data and case histories showing neurological status and complications related to intraventricular treatment. The results between those who died and the survivors were compared. RESULTS: Intraventricular fibrinolysis was performed in 42 patients (69% males) with intraventricular hemorrhage. The average age was 58.36 years (SD 16.67), with a median APACHE II score of 17.5 (r 3-29). A total of 16.7% were receiving acenocoumarol, and 7.1% were on antiplatelet drugs. The median Glasgow Coma Score at the start of treatment was 8 (r 3-13). The median Graeb score was 9 (r 6-12), and was severe (Graeb 9-12) in almost 62%. In turn, 26.2% of the patients developed ventriculitis, and there was further bleeding in 7.1%. Death occurred in 50% of the cases. None of the analyzed variables were significantly related to increased mortality. In the 21 survivors, the Glasgow Outcome Score at 3 months was 2 in 23.8% of the cases, 3 in 28.57%, 4 in 23.8% and 5 in 28.57% of the patients. CONCLUSIONS: Intraventricular fibrinolysis does not appear to involve a high rate of complications, and may result in lesser mortality, with a better functional outcome after three months than that estimated and published in the literature in reference to intraventricular hemorrhage.