Comparative efficacy of urokinase and recombinant tissue-type plasminogen activators in intraventricular hemorrhage

Objective: Spontaneous intracerebral hemorrhage (ICH) with intraventricular hemorrhage (IVH) is associated with high mortality and severe disability. This study aimed to compare the effects of urokinase-type plasminogen activator (uPA) and recombinant tissue-type plasminogen activator (r-tPA) on functional outcomes and IVH clearance in patients with IVH. Methods: A retrospective analysis was conducted on 97 patients with IVH treated from January 2014 to February 2024. Patients received either uPA or r-tPA via external ventricular drainage (EVD) and were assessed using the modified Rankin Scale (mRS) at 180 days. Prognostic factors were analyzed to evaluate the treatment effects. Results: The 180-day mRS outcomes were similar between the uPA and r-tPA groups (P = 0.817). However, r-tPA achieved faster IVH clearance (P = 0.022) with shorter dosing and drain durations. By postoperative day 3, the IVH volume significantly decreased in the r-tPA group, allowing earlier intraventricular fibrinolysis cessation. ICU stays were shorter and infection rates lower in the r-tPA group, but these differences were not statistically significant. Multivariate analysis identified the NIHSS and initial ICH volume as key outcome predictors (P = 0.048, P = 0.035). Conclusion: While r-tPA facilitated faster IVH clearance, it did not improve long-term functional outcomes. Faster clearance with r-tPA may help reduce ICU stays and infection rates, but initial neurological status remains a primary prognostic factor. Larger studies are needed to confirm these findings and evaluate the potential benefits of r-tPA in IVH management.