Comparative efficacy of urokinase and recombinant tissue-type plasminogen activators in intraventricular hemorrhage

Spontaneous intracerebral hemorrhage (ICH) with intraventricular hemorrhage (IVH) is associated with high mortality and severe disability. This study aimed to compare the effects of urokinase-type plasminogen activator (uPA) and recombinant tissue-type plasminogen activator (r-tPA) on functional outcomes and IVH clearance in patients with IVH.

A retrospective analysis was conducted on 97 patients with IVH treated from January 2014 to February 2024. Patients received either uPA or r-tPA via external ventricular drainage (EVD) and were assessed using the modified Rankin Scale (mRS) at 180 days. Prognostic factors were analyzed to evaluate the treatment effects.

The 180-day mRS outcomes were similar between the uPA and r-tPA groups (P = 0.817). However, r-tPA achieved faster IVH clearance (P = 0.022) with shorter dosing and drain durations. By postoperative day 3, the IVH volume significantly decreased in the r-tPA group, allowing earlier intraventricular fibrinolysis cessation. ICU stays were shorter and infection rates lower in the r-tPA group, but these differences were not statistically significant. Multivariate analysis identified the NIHSS and initial ICH volume as key outcome predictors (P = 0.048, P = 0.035).

While r-tPA facilitated faster IVH clearance, it did not improve long-term functional outcomes. Faster clearance with r-tPA may help reduce ICU stays and infection rates, but initial neurological status remains a primary prognostic factor. Larger studies are needed to confirm these findings and evaluate the potential benefits of r-tPA in IVH management.