Skip to main content
Journal cover image

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

Publication ,  Journal Article
Ionita, CC; Ferrara, J; McDonagh, DL; Grossi, P; Graffagnino, C
Published in: Neurocrit Care
2005

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.

Duke Scholars

Published In

Neurocrit Care

DOI

ISSN

1541-6933

Publication Date

2005

Volume

3

Issue

3

Start / End Page

246 / 248

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Tissue Plasminogen Activator
  • Thalamus
  • Recombinant Proteins
  • Neurology & Neurosurgery
  • Middle Aged
  • Intracranial Thrombosis
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ionita, C. C., Ferrara, J., McDonagh, D. L., Grossi, P., & Graffagnino, C. (2005). Systemic hemostasis with recombinant-activated factor VII followed by local thrombolysis with recombinant tissue plasminogen activator in intraventricular hemorrhage. Neurocrit Care, 3(3), 246–248. https://doi.org/10.1385/NCC:3:3:246
Ionita, Catalina C., Joseph Ferrara, David L. McDonagh, Peter Grossi, and Carmelo Graffagnino. “Systemic hemostasis with recombinant-activated factor VII followed by local thrombolysis with recombinant tissue plasminogen activator in intraventricular hemorrhage.Neurocrit Care 3, no. 3 (2005): 246–48. https://doi.org/10.1385/NCC:3:3:246.
Ionita, Catalina C., et al. “Systemic hemostasis with recombinant-activated factor VII followed by local thrombolysis with recombinant tissue plasminogen activator in intraventricular hemorrhage.Neurocrit Care, vol. 3, no. 3, 2005, pp. 246–48. Pubmed, doi:10.1385/NCC:3:3:246.
Journal cover image

Published In

Neurocrit Care

DOI

ISSN

1541-6933

Publication Date

2005

Volume

3

Issue

3

Start / End Page

246 / 248

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Tissue Plasminogen Activator
  • Thalamus
  • Recombinant Proteins
  • Neurology & Neurosurgery
  • Middle Aged
  • Intracranial Thrombosis
  • Humans