Article Commentary: “Association of Intraventricular Fibrinolysis With Clinical Outcomes in ICH”
Ericka Samantha Teleg, MD
Kuramatsu JB, Gerner ST, Ziai WC, Bardutzky J, Sembill JA, Sprügel MI, Mrochen A, Kölbl K, Ram M, Avadhani R, et al. Association of Intraventricular Fibrinolysis With Clinical Outcomes in ICH: An Individual Participant Data Meta-Analysis. Stroke. 2022.
This meta-analysis examines the utilization of intraventricular fibrinolysis (IVF) and its impact on clinical outcomes in intracerebral hemorrhage. Despite several studies showing intraventricular clot resolution and safety among an intracerebral hemorrhage (ICH) population with a small hematoma volume but larger intraventricular hemorrhage volumes, the primary efficacy analyses for functional outcomes were neutral. Thus, tailoring clinical selection of patients that may benefit from IVF may determine functional benefit.
The statistical method that the authors have utilized to summarize data from several trials and observational data is crucial, as this kind of method used in meta-analysis preserves the clustering of the cohorts of patients from the different studies. This method also allows a large sample to be studied. This is the strength of the data and its results. The Individual Participant Data meta-analysis included 9 studies. The IPD set was compiled and analyzed in an academic center, University Hospital Erlangen in Germany. The eligibility for IPD inclusion included the following: (1) supratentorial primary ICH or IVH with IVH causing acute hydrocephalus treated with an external ventricular drainage (EVD); (2) patients aged >18 years; (3) pre-morbid modified Rankin Scale (mRS) < 3; (4) >10 patients treated with IVF within each study framework; (5) no evidence of early care limitations or death within 48 hours after admission; (6) no evidence of secondary ICH-etiologies; (7) no other competing treatment intervention; (8) use of validated imaging methods; (9) standardized scoring of neurological status; (10) availability of standardized functional outcome assessed by the mRS.