Rapidity of hematoma resolution after fibrinolytic therapy for intracerebral hemorrhage has a favorable effect on functional outcome
Abstract Fibrinolytic therapy with tissue plasminogen activator (rtPA) is considered a promising treatment option for intracerebral hemorrhage (ICH), but a large randomized controlled study (i.e., MISTIE III) failed to show a benefit for the long-term outcome. This study investigated whether the rap...
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Nature Portfolio
2025-05-01
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| author | Vesna Malinova Regina Schwiddessen Christian von der Brelie Dorothee Mielke Veit Rohde |
| author_facet | Vesna Malinova Regina Schwiddessen Christian von der Brelie Dorothee Mielke Veit Rohde |
| author_sort | Vesna Malinova |
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| description | Abstract Fibrinolytic therapy with tissue plasminogen activator (rtPA) is considered a promising treatment option for intracerebral hemorrhage (ICH), but a large randomized controlled study (i.e., MISTIE III) failed to show a benefit for the long-term outcome. This study investigated whether the rapidity of hematoma volume reduction influences outcome of ICH-patients undergoing fibrinolytic therapy. Patients with supratentorial ICH with or without a secondary extension to the ventricular system receiving fibrinolytic therapy from 2010 to 2020 were retrospectively analyzed. Patients with primarily intraventricular hemorrhage were excluded. A catheter was placed into the hematoma via burr hole and by means of neuronavigation. After confirming a correct catheter position rtPA was injected through the catheter with subsequent passive drainage of the hematoma. Hematoma volume was measured initially and 24/48/72 hours after treatment and the relative volume reduction was calculated. The functional outcome at discharge was assessed using the modified Rankin scale (mRS) regarding a mRS of 4 or lower as favorable outcome. A total of 280 patients with mean age of 69.6 years and mean hematoma volume of 55.6 ml were analyzed. The odds of reaching favorable outcome were four-fold higher in patients with a volume reduction of more than 50% after 24 h (OR 4.23, 95%CI 3.05 to 5.66, p = 0.007). Patients with a residual volume of less than 30 ml after 24 h had a two-fold higher chance of having favorable outcome (OR 2.9, 95%CI 1.78 to 4.63, p < 0.0001). A fast volume reduction of at least 50% within 24 h resulted into a favorable outcome in ICH-patients undergoing fibrinolytic therapy. Not just the amount but also the rapidity of hematoma volume reduction seems to be an important factor for a good clinical result after fibrinolytic therapy. |
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| spelling | doaj-art-560697cd0da3461ca507a2e398646ff32025-08-20T01:47:29ZengNature PortfolioScientific Reports2045-23222025-05-011511810.1038/s41598-025-00469-6Rapidity of hematoma resolution after fibrinolytic therapy for intracerebral hemorrhage has a favorable effect on functional outcomeVesna Malinova0Regina Schwiddessen1Christian von der Brelie2Dorothee Mielke3Veit Rohde4Department of Neurosurgery, University Medical Center GöttingenDepartment of Neurosurgery, University Medical Center GöttingenDepartment of Neurosurgery, University Medical Center GöttingenDepartment of Neurosurgery, University Medical Center GöttingenDepartment of Neurosurgery, University Medical Center GöttingenAbstract Fibrinolytic therapy with tissue plasminogen activator (rtPA) is considered a promising treatment option for intracerebral hemorrhage (ICH), but a large randomized controlled study (i.e., MISTIE III) failed to show a benefit for the long-term outcome. This study investigated whether the rapidity of hematoma volume reduction influences outcome of ICH-patients undergoing fibrinolytic therapy. Patients with supratentorial ICH with or without a secondary extension to the ventricular system receiving fibrinolytic therapy from 2010 to 2020 were retrospectively analyzed. Patients with primarily intraventricular hemorrhage were excluded. A catheter was placed into the hematoma via burr hole and by means of neuronavigation. After confirming a correct catheter position rtPA was injected through the catheter with subsequent passive drainage of the hematoma. Hematoma volume was measured initially and 24/48/72 hours after treatment and the relative volume reduction was calculated. The functional outcome at discharge was assessed using the modified Rankin scale (mRS) regarding a mRS of 4 or lower as favorable outcome. A total of 280 patients with mean age of 69.6 years and mean hematoma volume of 55.6 ml were analyzed. The odds of reaching favorable outcome were four-fold higher in patients with a volume reduction of more than 50% after 24 h (OR 4.23, 95%CI 3.05 to 5.66, p = 0.007). Patients with a residual volume of less than 30 ml after 24 h had a two-fold higher chance of having favorable outcome (OR 2.9, 95%CI 1.78 to 4.63, p < 0.0001). A fast volume reduction of at least 50% within 24 h resulted into a favorable outcome in ICH-patients undergoing fibrinolytic therapy. Not just the amount but also the rapidity of hematoma volume reduction seems to be an important factor for a good clinical result after fibrinolytic therapy.https://doi.org/10.1038/s41598-025-00469-6Intracerebral hematomaFibrinolytic therapyFunctional outcome |
| spellingShingle | Vesna Malinova Regina Schwiddessen Christian von der Brelie Dorothee Mielke Veit Rohde Rapidity of hematoma resolution after fibrinolytic therapy for intracerebral hemorrhage has a favorable effect on functional outcome Scientific Reports Intracerebral hematoma Fibrinolytic therapy Functional outcome |
| title | Rapidity of hematoma resolution after fibrinolytic therapy for intracerebral hemorrhage has a favorable effect on functional outcome |
| title_full | Rapidity of hematoma resolution after fibrinolytic therapy for intracerebral hemorrhage has a favorable effect on functional outcome |
| title_fullStr | Rapidity of hematoma resolution after fibrinolytic therapy for intracerebral hemorrhage has a favorable effect on functional outcome |
| title_full_unstemmed | Rapidity of hematoma resolution after fibrinolytic therapy for intracerebral hemorrhage has a favorable effect on functional outcome |
| title_short | Rapidity of hematoma resolution after fibrinolytic therapy for intracerebral hemorrhage has a favorable effect on functional outcome |
| title_sort | rapidity of hematoma resolution after fibrinolytic therapy for intracerebral hemorrhage has a favorable effect on functional outcome |
| topic | Intracerebral hematoma Fibrinolytic therapy Functional outcome |
| url | https://doi.org/10.1038/s41598-025-00469-6 |
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