Intraventricular Rt-PA in Patients With Intraventricular Hemorrhage
Intraventricular Rt-PA in Patients With Intraventricular Hemorrhage
This is a study to evaluate how recombinant tissue plasminogen activator (rt-PA) is utilized
 in patients with intraventricular hemorrhage (IVH). rt-PA is a drug that has been shown to
 dissolve blood, and may allow intraventricular catheters to be more effective for a longer
 period of time.
IVH occurs in about 40 percent of intracerebral hemorrhage cases and 15 percent of aneurysmal
 subarachnoid hemorrhage cases. Evidence supports a strong contribution of IVH to morbidity
 and mortality after cerebral hemorrhage. External ventricular drainage (EVD) is required
 clinical management; however, EVD via intraventricular catheter alone fails to prevent much
 of the morbidity and mortality of IVH. This study seeks to demonstrate the safety and
 efficacy of intraventricular thrombolysis, using rt-PA, as a method of removing this blood
 and altering morbidity and mortality. Patients will receive intraventricular injections of
 rt-PA or placebo every 12 hours. They will be followed prospectively with daily head CT scans
 during the acute-treatment phase and again between Days 28 and 32.

 Completion date provided represents the completion date of the grant per OOPD records
Inclusion criteria:

 -  Intraventricular hemorrhage (IVH) confirmed by CT scan

 -  More than 12 hours post bleed

 -  Hematoma size stable by CT scan

 -  Post-IVH catheter CT scan

 -  Able to begin study within 24 hours of bleed

 Exclusion criteria:

 -  Infratentorial bleed

 -  Supratentorial bleed greater than 30 cc

 -  Unclipped aneurysm suspected

 -  Arteriovenous malformation suspected

 -  Any severe, complicating illness (e.g., AIDS or DNR)

 -  Cardiovascular parameters that could confound study (e.g., myocardial infarction,
 pulmonary emboli, systemic fibrinolysis)

 -  Active internal bleeding

 -  Requirement for heparin doses greater than 10,000 U/day

 -  Concurrent coumadin

 -  Known allergy to rt-PA

 -  Pregnancy