Objective: Intraventricular hemorrhage (IVH) is deemed to result in poor outcomes in patients
with aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to explore the efficacy
and safety of intraventricular injections of recombinant tissue plasminogen activator (rt-PA).
Methods: We searched MEDLINE, EMBASE, and Cochrane Library from January 1980 to March 2015
for studies in English. The primary outcome was good functional improvement. The secondary outcomes
were angiographic vasospasm, acute obstructive hydrocephalus, hemorrhage rate, and mortality.
Results: Three observational studies and 3 randomized controlled trials (RCTs) with 217 patients were included
in the present study. There is a significant difference in angiographic vasospasm (RR 0.58, 95% CI
0.16 to 0.85, P = 0.01). In the subgroup analysis, angiographic vasospasm (RR 0.37, 95% CI 0.38 to 0.88, P
= 0.02) and acute obstructive hydrocephalus (RR 0.48, 95% CI 0.27 to 0.84, P = 0.01) showed significant
differences in the observational studies. High dosage of rt-PA showed a significant difference in angiographic
vasospasm (RR 0.60, 95% CI 0.38 to 0.97, P = 0.04). Sensitivity analysis showed that no significant
differences were observed in all the outcomes after the Ramakrishna 2010 trial was excluded.
Conclusion: Intraventricular rt-PA has no significant efficacy on the long-term functional recovery
after aneurysmal SAH with IVH. However, high dosage of rt-PA might reduce the incidence of angiographic
vasospasm. A feasible, large-scale, multi-center, placebo RCT is needed to confirm the present