Intraventricular hemorrhage (IVH) is a critical acute cerebrovascular disorder that leads to high mortality and disability in adults; it often occurs secondary to spontaneous intracranial hemorrhage (ICH). The IVH mortality rate is 45–80% [1] and the mortality rate of IHC concomitant with IVH is approximately 80% [2]. Although 38% of patients who experience an IVH survive the first year, the majority of survivors are disabled [3], as IVH can result in varying degrees of acute obstructive hydrocephalus, leading to delayed recovery or worsening brain function [2]. Therefore, managing and improving the prognosis of patients with IVH remains a challenge for neurosurgeons.

Currently, urokinase-type plasminogen activator (uPA) and recombinant tissue plasminogen activator (rt-PA) are used in clinical practice after placement of an extra-ventricular drainage (EVD) system, and they effectively reduce the hematoma volume in the ventricles and parenchyma [4], [5]. Rt-PA is the first choice for thrombolytic therapy in the United States. However, there are clinical trials that indicate that rt-PA does not substantially improve functional outcomes of IVH. The CLEAR III trial noted that although the use of rt-PA appeared to be safe, there was no clear positive impact on clinical outcome, which is the goal of every therapy used in patients with brain injuries [6]. Other studies suggest that using thrombolytic medicine like rt-PA could lead to unpredictable outcomes [7]. However, the quality of studies, including retrospective and case-control studies, varied widely; furthermore, these studies had a limited sample size [8], [9], [10], [11], [12], [13]. Such differences in study design and sample size make it difficult to evaluate the efficacy of rt-PA. As another nonspecific fibrinogen activator, various studies support the possibility that uPA is a promising candidate for fibrinolytic therapy for managing ICH and IVH [9], [10], [11], [12], [13], [14], [15], [16]. Hence, whether uPA can improve patient outcomes requires further investigation.

We conducted a retrospective cohort study of EVD treatment for IVH over a three-year period, with and without adjuvant uPA administration, which is widely used in primary care hospitals in China. This study aimed to evaluate the safety and efficacy of EVD combined with uPA in the management of IVH.