Blood clot resolution using active fluid exchange in the treatment of intraventricular hemorrhage

Objective Intraventricular hemorrhage (IVH) is a severe condition with poor outcome and high mortality. New treatments are warranted to facilitate clot removal and accelerate recovery of IVH patients. We examined the effect to intraventricular lavage on IVH resolution, clearance and kinectics. The study is a post-hoc study on a recently performed randomized study, where intraventricular lavage using controlled irrigation and aspiration was tested against passive drainage. The present study describe post hoc analysis of the Active Study to determine the effect of intraventricular lavage on IVH resolution clearance and kinetics. Method postPost-hoc analysis using data from the multi-center, randomized, controlled clinical safety/feasibility trial (Active Study, NCT05204849 ) including 21 patients with IVH. IVH clearance was assessed using volume segmentation of serial CT scans. Clot resolution kinetics were determined and correlated with irrigation rates. Results The data set consisted of 77 sequential CT scans from 18 patients (3 of the 21 patients included in the Active study were excluded due to rebleeding or only one CT scan performed). Baseline characteristics were equal in the two groups. Clot resolution followed 0-order kinetics. The clot half-life was 3.9 days in the group treated with intraventricular lavage compared to 5.3 days in the control group treated with passive drainage (p = 0.6). We did not observe accelerated clot resolution in the ventricles containing the catheter tip (3.9 days vs 3.6 days, p = 0.9). In the intervention group, clot resolution was increased by 0.05% per ml increase in irrigation (slope 1.576 ml/cm3 (95%CI 0.55-2.6) p=0.03) Conclusion We found that IVH clot resolution followed 0-order kinetics. No significant differences in clot half-life were observed between the two groups. However, the clot resolution rate was positively correlated with the irrigation rates.