Intraventricular Recombinant Tissue Plasminogen Activator in Treatment of Aneurysmal Intraventricular Hemorrhage: A Meta-Analysis

OBJECTIVE: Intraventricular hemorrhage (IVH) is deemed to result in poor outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to explore the efficacy and safety of intraventricular injections of recombinant tissue plasminogen activator (rt-PA). METHODS: We searched MEDLINE, EMBASE, and Cochrane Library from January 1980 to March 2015 for studies in English. The primary outcome was good functional improvement. The secondary outcomes were angiographic vasospasm, acute obstructive hydrocephalus, hemorrhage rate, and mortality. RESULTS: Three observational studies and 3 randomized controlled trials (RCTs) with 217 patients were included in the present study. There is a significant difference in angiographic vasospasm (RR 0.58, 95% CI 0.16 to 0.85, P = 0.01). In the subgroup analysis, angiographic vasospasm (RR 0.37, 95% CI 0.38 to 0.88, P = 0.02) and acute obstructive hydrocephalus (RR 0.48, 95% CI 0.27 to 0.84, P = 0.01) showed significant differences in the observational studies. High dosage of rt-PA showed a significant difference in angiographic vasospasm (RR 0.60, 95% CI 0.38 to 0.97, P = 0.04). Sensitivity analysis showed that no significant differences were observed in all the outcomes after the Ramakrishna 2010 trial was excluded. CONCLUSION: Intraventricular rt-PA has no significant efficacy on the long-term functional recovery after aneurysmal SAH with IVH. However, high dosage of rt-PA might reduce the incidence of angiographic vasospasm. A feasible, large-scale, multi-center, placebo RCT is needed to confirm the present findings.