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A 'counterintuitive approach': low-dose rTPA helps in hemorrhagic stroke.

SAN DIEGO -- Targeted thrombolysis sped the reduction of clots associated with spontaneous intraventricular hemorrhage, Dr. Daniel Hanley reported during a press briefing at the 29th International Stroke Conference.

Draining the blood with a catheter while applying a low dose of recombinant tissue plasminogen activator (rTPA) to the injured area is a "counterintuitive approach" that could improve the treatment of hemorrhagic stroke, said Dr. Hanley, director of brain injury outcomes at Johns Hopkins University, Baltimore. The rTPA approach reduced clots by as much as an additional 50% compared with placebo.

Dr. Hanley was the lead investigator in a trial funded through the Food and Drug Administration's orphan drug program; Genentech supplied the study drug.

He and his associates conducted a randomized, double-blind, and placebo-controlled study of 48 patients with intraventricular hemorrhage. The average age of participants was 56 years. Most (56%) were African American; the rest were white (21%), Hispanic (15%), and Asian (8%).

An intraventricular catheter was used to remove blood from the brain and patients were then randomized to receive through the catheter either rTPA 3 mg or saline placebo every 12 hours. Investigators monitored clot removal and recurrent bleeding with daily CT scans.

"We use ultra-low-dose rTPA and deliver it directly to the clot," Dr. Hanley explained at the conference, which was sponsored by the American Stroke Association.

Clot-reduction rate averaged 18% per day and was as high as 50% per day in patients who received rTPA. Clot-reduction rate averaged 10% per day among those who took placebo. In addition, patients treated with rTPA had fewer adverse events and ventilator complications, and less prolonged or multiple catheter use. Alternatively, more patients in the activedrug group had symptomatic bleeding a week after the spontaneous intraventricular hemorrhage: The rate was 23% among those who took rTPA and 6% among those who took placebo.

A separate trial is now underway to determine the lowest dose of rTPA that can be used to remove clots without causing secondary bleeding.

In the United States, an estimated 37,000-52,400 people have a spontaneous intraventricular hemorrhage each year. The condition accounts for 10%-15% of all stroke cases.

BY DOUG BRUNK

San Diego Bureau
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Title Annotation:recombinant tissue plasminogen activator
Author:Brunk, Doug
Publication:Internal Medicine News
Geographic Code:1U9CA
Date:Apr 1, 2004
Words:360
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