Article
The contribution of haematoma volume reduction celerity to the efficacy of fibrinolytic therapy and to functional outcome in patients with spontaneous intracerebral haemorrhage – Not just a question of how much but also of how fast?
Beitrag der Schnelligkeit der Volumenreduktion des Hämatoms auf die Effektivität der Lysetherapie und auf die Prognose der Patienten mit spontaner intrazerebraler Blutung
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Authors
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Vesna Malinova
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Beate Kranawetter
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Regina Schwiddessen
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Christian von der Brelie
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Minimally invasive surgery (MIS) combined with tissue plasminogen activator (rtPA) fibrinolysis is considered a promising treatment option, however, a randomized trial failed to demonstrate a functional outcome benefit. Several factors have been identified to influence the efficacy of fibrinolytic therapy increasing the odds of reaching a better outcome, whereas the role of the ICH-volume reduction celerity has not been determined yet. We aimed to evaluate the contribution of ICH-volume reduction celerity to functional outcome of ICH-patients undergoing fibrinolytic therapy.
Methods: A retrospective analysis of patients with ICH treated with fibrinolytic therapy at our department from 2010 to 2020 was performed. Hematoma volume was measured initially as well as after each rtPA dose, and the relative volume reduction after 24h, 48h and 72h was calculated. The patients' outcome at discharge was calculated according to the modified Rankin scale (mRS). The correlation of hematoma volume reduction celerity with patients' outcome was evaluated.
Results: A total of 280 patients were included in the study. The mean age of the patients was 69.6±12.5 years with a mean initial hematoma volume of 55.6±27.6 ml. In 54% the hematoma was deep-seated and 46% had lobar ICH. A mRS ≦ 4 at discharge had 50% of the patients, and mRS ≦ 3 only 7%. A faster ICH volume reduction of at least 50% of the initial hematoma volume already after 24h was associated with better outcome (p=0.005). In contrast to that a volume reduction of >70% after 72h had no impact on functional outcome. A residual volume of <30 ml after 24h was correlated to better outcome (p<0.0001). The patients with <20ml residual hematoma after 48h had a three-fold higher chance of reaching mRS of at least 4 or lower at discharge (OR 3.6, p<0.0001).
Conclusion: A faster hematoma volume reduction of at least 50% of the initial ICH volume within 24h resulted in better functional outcome in ICH-patients undergoing fibrinolytic therapy. The identification of further factors associated with faster and more efficient ICH volume reduction may improve the effectiveness of fibrinolytic therapy and increase the number of patients achieving a mRS of at least 4 or lower at discharge as a prerequisite for neurological improvement during the following rehabilitation.
