Can you believe you would treat Intra Cranial hemorrhage with Thromolytics. Bleed on CT scan is one of the contraindications for giving rTPA in stroke. If you don't believe me you can see this guideline. It will make them bleed more.
This study is published in Medscape that low dose rTPA safe and effective in treating Intra ventricular hemorrhage, The researchers developed a system where tPA could be delivered directly to the site of the clot with a catheter placed by a neurosurgeon. When patients with intraventricular hemorrhage were given 1mg tPA every 8 hours for 4 days (usual dose for treating ischemic strokes is 100 mg over 90 minutes), their mortality rate dropped from 80% to 15%! In other words, before researchers tried this therapy, 8 out of 10 patients died from intraventricular bleeding. In this study less than 2 out of 10 patients died from intraventricular hemorrhage. In addition, the functional outcomes of the survivors was significantly better (i.e. less people had long-term disability).
More information for the study can be found on the Johns Hopkins web site. The information on inclusion and exclusion criteria is here. Obviously this therapy isn’t ready for prime-time yet, but there’s a lot of promise here.
It must have taken a lot of bravery to give the first patient with recent onset brain bleeding a dose of a thrombolytics, but that type of “outside the box” thinking will save a lot of lives and prevent a lot of disability.
Amazing!!
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