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

Research output: Contribution to journalShort survey

5 Scopus citations

Abstract

Introdution: 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 non-functional. 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.

Original languageEnglish (US)
Pages (from-to)246-248
Number of pages3
JournalNeurocritical Care
Volume3
Issue number3
DOIs
StatePublished - Dec 2005

Keywords

  • Activated factor VII
  • Intracranial hemorrhage
  • Intraventricular hemorrhage
  • Tissue plasminogen activator

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Systemic hemostasis with recombinant-activated factor VII followed by local thrombolysis with recombinant tissue plasminogen activator in intraventricular hemorrhage'. Together they form a unique fingerprint.

  • Cite this