Az agykamrába töro vérzések lokális fibrinolízisének biztonságossága és hatékonysága (prospektív, randomizált vizsgálat).

Translated title of the contribution: Effectiveness and safety of intraventricular fibrinolysis in secondary intraventricular hemorrhages (a prospective, randomized study)

István Gubucz, Ilona Kakuk, Ottó Major, Norbert Szegedi, P. Barsi, Gyula Pánczél, Dániel Varga, Csaba Ovary, Zsolt May, Gabriella Ricsói, Júlia Kenéz, Géza Szilágyi, Zoltán Nagy

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Intraventricular clot secondary to brain hemorrhage has still one of the worst prognosis among all stroke subtypes, regardless of conservative therapy or surgical interventions. The rapid clot resolution with thrombolytic agents could improve the outcome by restoring the impaired cerebrospinal fluid circulation, for this reason, the authors examined the safety and efficacy of Urokinase therapy in a randomized, controlled study. METHODS: They enrolled 27 patients with severe intraventricular hemorrhage between 1998 and 2002. All patients had supratentorial intracerebral hemorrhage caused by hypertension, with IVH, moreover clinically worsening course due to the obstructive hydrocephalus confirmed by CT. Eleven persons were treated with ventriculostomy alone and 16 received adjunctive intraventricular urokinase. The authors examined the early, 30-day and 1-year mortality, furthermore the neurological (Scandinavian Stroke Scale) and functional outcome (Barthel Scale). The mean age was 60 +/- 9.5. The initial Scandinavian Stroke Scale was 7.51 +/- 8.64, Glasgow Coma Scale was 6.85 +/- 2.52, intracerebral hemorrhage volume was 22.44 +/- 18.14 ml. RESULTS: The 1 year survival rate was significant higher in the urokinase treated group (p = 0.014), This tendency in the mortality (31.3% vs. 54.5%) and in the neurological/functional condition (SSS, p = 0.078/Barthel, p = 0.119) at 30th day have been also documented. No hemorrhagic complications due to urokinase were observed. Two meningitis (7.4%) and two intraparenchymal hemorrhages (7.4%) related to drain insertion were detected (p = 0.009). The probability of pulmonary infection was roughly two times higher in the group without clot lysis (RR = 1.870; 95% CI: 1.004-3.482). CONCLUSIONS: In the authors experience, urokinase treatment reveals to be safe in the intraventricular clot lysis. This therapy allows earlier mobilization and rehabilitation, and decreases the number of infections, which are favorable to the long-term survival rate.

Original languageHungarian
Pages (from-to)1609-1615
Number of pages7
JournalOrvosi Hetilap
Volume145
Issue number31
Publication statusPublished - Aug 1 2004

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Urokinase-Type Plasminogen Activator
Fibrinolysis
Prospective Studies
Hemorrhage
Safety
Stroke
Cerebral Hemorrhage
Survival Rate
Ventriculostomy
Early Ambulation
Glasgow Coma Scale
Fibrinolytic Agents
Mortality
Intracranial Hemorrhages
Hydrocephalus
Infection
Meningitis
Cerebrospinal Fluid
Therapeutics
Rehabilitation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Az agykamrába töro vérzések lokális fibrinolízisének biztonságossága és hatékonysága (prospektív, randomizált vizsgálat). / Gubucz, István; Kakuk, Ilona; Major, Ottó; Szegedi, Norbert; Barsi, P.; Pánczél, Gyula; Varga, Dániel; Ovary, Csaba; May, Zsolt; Ricsói, Gabriella; Kenéz, Júlia; Szilágyi, Géza; Nagy, Zoltán.

In: Orvosi Hetilap, Vol. 145, No. 31, 01.08.2004, p. 1609-1615.

Research output: Contribution to journalArticle

Gubucz, I, Kakuk, I, Major, O, Szegedi, N, Barsi, P, Pánczél, G, Varga, D, Ovary, C, May, Z, Ricsói, G, Kenéz, J, Szilágyi, G & Nagy, Z 2004, 'Az agykamrába töro vérzések lokális fibrinolízisének biztonságossága és hatékonysága (prospektív, randomizált vizsgálat).', Orvosi Hetilap, vol. 145, no. 31, pp. 1609-1615.
Gubucz, István ; Kakuk, Ilona ; Major, Ottó ; Szegedi, Norbert ; Barsi, P. ; Pánczél, Gyula ; Varga, Dániel ; Ovary, Csaba ; May, Zsolt ; Ricsói, Gabriella ; Kenéz, Júlia ; Szilágyi, Géza ; Nagy, Zoltán. / Az agykamrába töro vérzések lokális fibrinolízisének biztonságossága és hatékonysága (prospektív, randomizált vizsgálat). In: Orvosi Hetilap. 2004 ; Vol. 145, No. 31. pp. 1609-1615.
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abstract = "BACKGROUND AND PURPOSE: Intraventricular clot secondary to brain hemorrhage has still one of the worst prognosis among all stroke subtypes, regardless of conservative therapy or surgical interventions. The rapid clot resolution with thrombolytic agents could improve the outcome by restoring the impaired cerebrospinal fluid circulation, for this reason, the authors examined the safety and efficacy of Urokinase therapy in a randomized, controlled study. METHODS: They enrolled 27 patients with severe intraventricular hemorrhage between 1998 and 2002. All patients had supratentorial intracerebral hemorrhage caused by hypertension, with IVH, moreover clinically worsening course due to the obstructive hydrocephalus confirmed by CT. Eleven persons were treated with ventriculostomy alone and 16 received adjunctive intraventricular urokinase. The authors examined the early, 30-day and 1-year mortality, furthermore the neurological (Scandinavian Stroke Scale) and functional outcome (Barthel Scale). The mean age was 60 +/- 9.5. The initial Scandinavian Stroke Scale was 7.51 +/- 8.64, Glasgow Coma Scale was 6.85 +/- 2.52, intracerebral hemorrhage volume was 22.44 +/- 18.14 ml. RESULTS: The 1 year survival rate was significant higher in the urokinase treated group (p = 0.014), This tendency in the mortality (31.3{\%} vs. 54.5{\%}) and in the neurological/functional condition (SSS, p = 0.078/Barthel, p = 0.119) at 30th day have been also documented. No hemorrhagic complications due to urokinase were observed. Two meningitis (7.4{\%}) and two intraparenchymal hemorrhages (7.4{\%}) related to drain insertion were detected (p = 0.009). The probability of pulmonary infection was roughly two times higher in the group without clot lysis (RR = 1.870; 95{\%} CI: 1.004-3.482). CONCLUSIONS: In the authors experience, urokinase treatment reveals to be safe in the intraventricular clot lysis. This therapy allows earlier mobilization and rehabilitation, and decreases the number of infections, which are favorable to the long-term survival rate.",
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T1 - Az agykamrába töro vérzések lokális fibrinolízisének biztonságossága és hatékonysága (prospektív, randomizált vizsgálat).

AU - Gubucz, István

AU - Kakuk, Ilona

AU - Major, Ottó

AU - Szegedi, Norbert

AU - Barsi, P.

AU - Pánczél, Gyula

AU - Varga, Dániel

AU - Ovary, Csaba

AU - May, Zsolt

AU - Ricsói, Gabriella

AU - Kenéz, Júlia

AU - Szilágyi, Géza

AU - Nagy, Zoltán

PY - 2004/8/1

Y1 - 2004/8/1

N2 - BACKGROUND AND PURPOSE: Intraventricular clot secondary to brain hemorrhage has still one of the worst prognosis among all stroke subtypes, regardless of conservative therapy or surgical interventions. The rapid clot resolution with thrombolytic agents could improve the outcome by restoring the impaired cerebrospinal fluid circulation, for this reason, the authors examined the safety and efficacy of Urokinase therapy in a randomized, controlled study. METHODS: They enrolled 27 patients with severe intraventricular hemorrhage between 1998 and 2002. All patients had supratentorial intracerebral hemorrhage caused by hypertension, with IVH, moreover clinically worsening course due to the obstructive hydrocephalus confirmed by CT. Eleven persons were treated with ventriculostomy alone and 16 received adjunctive intraventricular urokinase. The authors examined the early, 30-day and 1-year mortality, furthermore the neurological (Scandinavian Stroke Scale) and functional outcome (Barthel Scale). The mean age was 60 +/- 9.5. The initial Scandinavian Stroke Scale was 7.51 +/- 8.64, Glasgow Coma Scale was 6.85 +/- 2.52, intracerebral hemorrhage volume was 22.44 +/- 18.14 ml. RESULTS: The 1 year survival rate was significant higher in the urokinase treated group (p = 0.014), This tendency in the mortality (31.3% vs. 54.5%) and in the neurological/functional condition (SSS, p = 0.078/Barthel, p = 0.119) at 30th day have been also documented. No hemorrhagic complications due to urokinase were observed. Two meningitis (7.4%) and two intraparenchymal hemorrhages (7.4%) related to drain insertion were detected (p = 0.009). The probability of pulmonary infection was roughly two times higher in the group without clot lysis (RR = 1.870; 95% CI: 1.004-3.482). CONCLUSIONS: In the authors experience, urokinase treatment reveals to be safe in the intraventricular clot lysis. This therapy allows earlier mobilization and rehabilitation, and decreases the number of infections, which are favorable to the long-term survival rate.

AB - BACKGROUND AND PURPOSE: Intraventricular clot secondary to brain hemorrhage has still one of the worst prognosis among all stroke subtypes, regardless of conservative therapy or surgical interventions. The rapid clot resolution with thrombolytic agents could improve the outcome by restoring the impaired cerebrospinal fluid circulation, for this reason, the authors examined the safety and efficacy of Urokinase therapy in a randomized, controlled study. METHODS: They enrolled 27 patients with severe intraventricular hemorrhage between 1998 and 2002. All patients had supratentorial intracerebral hemorrhage caused by hypertension, with IVH, moreover clinically worsening course due to the obstructive hydrocephalus confirmed by CT. Eleven persons were treated with ventriculostomy alone and 16 received adjunctive intraventricular urokinase. The authors examined the early, 30-day and 1-year mortality, furthermore the neurological (Scandinavian Stroke Scale) and functional outcome (Barthel Scale). The mean age was 60 +/- 9.5. The initial Scandinavian Stroke Scale was 7.51 +/- 8.64, Glasgow Coma Scale was 6.85 +/- 2.52, intracerebral hemorrhage volume was 22.44 +/- 18.14 ml. RESULTS: The 1 year survival rate was significant higher in the urokinase treated group (p = 0.014), This tendency in the mortality (31.3% vs. 54.5%) and in the neurological/functional condition (SSS, p = 0.078/Barthel, p = 0.119) at 30th day have been also documented. No hemorrhagic complications due to urokinase were observed. Two meningitis (7.4%) and two intraparenchymal hemorrhages (7.4%) related to drain insertion were detected (p = 0.009). The probability of pulmonary infection was roughly two times higher in the group without clot lysis (RR = 1.870; 95% CI: 1.004-3.482). CONCLUSIONS: In the authors experience, urokinase treatment reveals to be safe in the intraventricular clot lysis. This therapy allows earlier mobilization and rehabilitation, and decreases the number of infections, which are favorable to the long-term survival rate.

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