Document Detail

Systemic hemostasis with recombinant-activated factor VII followed by local thrombolysis with recombinant tissue plasminogen activator in intraventricular hemorrhage.
MedLine Citation:
PMID:  16377837     Owner:  NLM     Status:  MEDLINE    
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.
Catalina C Ionita; Joseph Ferrara; David L McDonagh; Peter Grossi; Carmelo Graffagnino
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurocritical care     Volume:  3     ISSN:  1541-6933     ISO Abbreviation:  Neurocrit Care     Publication Date:  2005  
Date Detail:
Created Date:  2005-12-26     Completed Date:  2006-02-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  246-8     Citation Subset:  IM    
Duke Neurosciences Critical Care Unit, Department of Medicine/Neurology, Duke University Medical Center, Durham, NC 27710, USA.
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MeSH Terms
Anticoagulants / therapeutic use
Cerebral Hemorrhage / complications*,  drug therapy*
Factor VIIa / therapeutic use*
Fibrinolytic Agents / therapeutic use*
Hematoma / drug therapy,  etiology
Hemostatic Techniques
Intracranial Thrombosis / drug therapy*,  etiology
Middle Aged
Recombinant Proteins
Thalamus / blood supply,  pathology
Tissue Plasminogen Activator / therapeutic use*
Tomography, X-Ray Computed
Treatment Outcome
Warfarin / therapeutic use
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Recombinant Proteins; 81-81-2/Warfarin; EC VIIa; EC Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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