Neurocritical Care

, Volume 3, Issue 3, pp 246–248 | Cite as

Systemic hemostasis with recombinant-activated factor VII followed by local thrombolysis with recombinant tissue plasminogen activator in intraventricular hemorrhage

  • Catalina C. Ionita
  • Joseph Ferrara
  • David L. McDonagh
  • Peter Grossi
  • Carmelo Graffagnino
Perspectives In thrombolysis And ICH

Abstract

Introduction: A 51-year-old woman on warfarin thromboprophylaxis for transient ischemic attacks developed sudden onset nausea, vomiting, and decreased mental status, rapidly becoming comatose. Head computed tomography (CT) showed intracerebral hemorrhage, extending into all ventricular chambers, and acute obstructive hematocephalus requiring urgent ventricular drainage. CT angiogram showed no evidence of an aneurysm or vascular malformation.

Methods: The pretreatment international normalized ratio (INR) of 4.9 was rapidly corrected with recombinant activated factor VII and an external ventricular drain was placed. Despite accurate positioning, the ventriculostomy thrombosed and became nonfunctional. Recombinant tissue plasminogen activator was given intraventricularly and resulted in partial ventricular decompression within 24 hours, with dramatic improvement in the patient’s level of consciousness.

Results: Repeated intraventricular fibrinolysis resulted in further reduction of the intraventricular hematoma within a few days and a good patient outcome. The patient did not require permanent ventricular shunt.

Conclusion: To our knowledge, this is the first reported case of combined systemic enhancement of hemostasis and local fibrinolysis as a life-saving measure in intracranial hemorrhage.

Key Words

Intraventricular hemorrhage intracranial hemorrhage activated factor VII tissue plasminogen activator 

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Copyright information

© Humana Press Inc 2005

Authors and Affiliations

  • Catalina C. Ionita
    • 3
  • Joseph Ferrara
    • 3
  • David L. McDonagh
    • 1
  • Peter Grossi
    • 2
  • Carmelo Graffagnino
    • 3
  1. 1.Duke Neurosciences Critical Care Unit, Department of AnesthesiologyDuke University Medical CenterDurham
  2. 2.Duke Neurosciences Critical Care Unit, Department of NeurosurgeryDuke University Medical CenterDurham
  3. 3.Duke Neurosciences Critical Care Unit, Department of Medicine/NeurologyUniversity Medical CenterDurham

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