Clot-buster lowers death risk in deadliest stroke

by Bruce Sylvester: Tissue plasminogen activator (tPA) treatment with the clot-busting drug alteplase appears to be an effective way to decrease mortality in intraventricular hemorrhage, a catastrophic type of bleeding stroke, researchers from the CLEAR III clinical trial reported on Feb. 18, 2016 at the International Stroke Conference in Los Angeles.

Alteplase/tPA treatment also significantly reduced post-stroke disability in a subset of patients.

“Hemorrhage in the brain used to be an essentially untreatable condition, but we now have hope with a therapy that may be effective at saving lives,” said Issam Awad, MD, professor of surgery at the University of Chicago School of Medicine, and co-chair and surgical director for the CLEAR III clinical trial.

The investigators in the phase III, randomized, double-blinded and controlled trial enrolled 500 intraventricular hemorrhage patients.

After stabilization, clinicians administered alteplase/tPA or saline directly into the ventricle through an external, surgically inserted catheter. The patients received the treatment for three days, and the catheter drained blood until the ventricle cleared.

The investigators reported that timely introduction of alteplase/tPA directly into the ventricle, and use of a drainage catheter, was associated with a reduction of overall mortality of 10 percent, and a third less deaths in the alteplase/tPA group compared to the saline group.

Notably, alteplase/tPA treatment almost doubled the probability of good functional recovery in patients with high volume bleeds who had had most of the blood removed.

“For many patients, this approach can significantly reduce disability after a stroke, and can be the difference between going home instead of going to a nursing home,” Awad said.

Co- lead investigator Daniel Hanley Jr., MD, professor of acute care Neurology at Johns Hopkins University School of Medicine in Baltimore added, “Outside our study, this drainage was only used in 8 percent of hemorrhagic stroke cases, and we showed this technique can really make a difference. Our results suggest that physicians should begin to think about routinely using it for stable hemorrhagic stroke patients.”