Early Lumbar Drainage for Intraventricular Hemorrhage (LD-IVH)
Effectiveness and Safety of Early Lumbar Drainage in the Treatment of Ventricular Hemorrhage: the LD-IVH Randomized Controlled Trial
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
Intraventricular hemorrhage (IVH) is a life-threatening complication of acute stroke, associated with high rates of mortality and severe disability, fewer than 20% of survivors achieve favorable functional outcomes. Despite the widespread use of external ventricular drainage (EVD) and intraventricular thrombolysis, the role of early lumbar drainage in improving outcomes remains controversial, with limited high-level evidence from randomized controlled trials.
The LD-IVH study will use a 1:1 stratified block randomization design, with stratification by intraparenchymal hematoma and hospital. Eligible patients will be randomized to receive either (1) control group treatment: standard EVD plus daily intrathecal urokinase (30,000 IU) for 3 consecutive days, with a maximum treatment duration of 5 days; or (2) intervention group treatment: the same EVD and intrathecal urokinase regimen as the control group, with early lumbar drainage additionally initiated within 72 hours of onset. CSF was drained at a rate of ≤8 mL/h, with a daily maximum volume of 200 mL, to keep intracranial pressure stable.
The primary endpoint will be the proportion of patients with a favorable functional outcome (modified Rankin Scale [mRS] score 0-3) at 180 days. A total of 392 patients will be enrolled, and an interim efficacy analysis is planned after 50% of participants complete the 180-day follow-up.
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Unzutreffend
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Ping Hu, MD
- Telefonnummer: +86 13097286794
- E-Mail: hp666edu@163.com
Studienorte
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Changde, China
- Changde First People's Hospital
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Kontakt:
- Changde First People's Hospital
- E-Mail: 936483206@qq.com
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Dezhou, China
- Lingcheng District People's Hospital
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Kontakt:
- E-Mail: weifawei35888999@163.com
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Dezhou, China
- Qilu Hospital of Shandong University Dezhou Hospital
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Kontakt:
- E-Mail: xushugang82@163.com
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Ganzhou, China
- The First Affiliated Hospital of Gannan Medical University
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Kontakt:
- The First Affiliated Hospital of Gannan Medical University
- E-Mail: zzbbchina@126.com
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Ganzhou, China
- Ganzhou People's Hospital
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Kontakt:
- Ganzhou People's Hospital
- E-Mail: yexinyun1270@163.com
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Ganzhou, China
- Ruijin People's Hospital
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Kontakt:
- Manchang Liu
- Telefonnummer: +8615970036188
- E-Mail: 61730146@qq.com
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Guiyang, China
- The Affiliated Hospital of Guizhou Medical University
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Kontakt:
- The Affiliated Hospital of Guizhou Medical University
- E-Mail: yhmed@163.com
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Hangzhou, China
- The First Affiliated Hospital of Zhejiang University school of medicine
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Kontakt:
- The First Affiliated Hospital of Zhejiang University School of
- E-Mail: gujun66@163.com
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Hefei, China
- The First Affiliated Hospital of Anhui Medical University
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Kontakt:
- The First Affiliated Hospital of Anhui Medical University
- E-Mail: chenjunhui101@163.com
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Jingdezhen, China
- Jingdezhen Second People's Hospital
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Kontakt:
- Jingdezhen Second People's Hospital
- E-Mail: 280960834@qq.com
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Jiujiang, China
- Jiujiang First People's Hospital
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Kontakt:
- Jiujiang First People's Hospital
- E-Mail: 40616665@qq.com
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Jiujiang, China
- The First People's Hospital of Xiushui County
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Kontakt:
- The First People's Hospital of Xiushui County
- E-Mail: lhb1062@163.com
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Ji’an, China
- Ji'an Central People's Hospital
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Kontakt:
- Ji'an Central People's Hospital
- E-Mail: Yjp8259309@163.com
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Lanzhou, China
- The Second Hospital of Lanzhou University
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Kontakt:
- The Second Hospital of Lanzhou University
- E-Mail: stone19871128@163.com
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Linyi, China
- Linyi People's Hospital
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Kontakt:
- Linyi People's Hospital
- E-Mail: drguofeng@163.com
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Luzhou, China
- The Affiliated Hospital of Southwest Medical University
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Kontakt:
- The Affiliated Hospital of Southwest Medical University
- E-Mail: yhmed@163.com
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Nanchang, China
- Second Affiliated Hospital of Nanchang University
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Kontakt:
- Ping Hu
- Telefonnummer: +8613097286794
- E-Mail: hp666edu@163.com
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Nanchang, China
- Nanchang Central Hospital
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Kontakt:
- Nanchang Central Hospital
- E-Mail: 1641853901@qq.com
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Panzhihua, China
- Panzhihua Central Hospital
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Kontakt:
- E-Mail: 32406201@qq.com
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Shiyan, China
- Taihe Hospital
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Kontakt:
- Taihe Hospital
- E-Mail: 68108261@qq.com
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Suzhou, China
- The 904th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army
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Kontakt:
- The 904th Hospital of the Joint Logistics Support Force of the
- E-Mail: chenjunhui1019@163.com
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Wenzhou, China
- The Second Affiliated Hospital of Wenzhou Medical University
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Kontakt:
- Hansong Sheng
- Telefonnummer: +8613587782218
- E-Mail: shs951052@163.com
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Yichang, China
- Yichang Central People's Hospital
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Kontakt:
- Yichang Central People's Hospital
- E-Mail: onedy@sina.com
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Yichun, China
- Zhangshu People's Hospital
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Kontakt:
- Zhangshu People's Hospital
- E-Mail: 33309779@qq.com
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Yingtan, China
- Yingtan People's Hospital
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Kontakt:
- Yingtan People's Hospital
- E-Mail: 20030182@163.com
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Zhangjiagang, China
- Zhangjiagang First People's Hospital
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Kontakt:
- Zhangjiagang First People's Hospital
- E-Mail: zhangli_syy@163.com
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Zhoukou, China
- Zhoukou Central Hospital
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Kontakt:
- Zhoukou Central Hospital
- E-Mail: 96978849@qq.com
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Zunyi, China
- Zunyi First People's Hospital
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Kontakt:
- Zunyi First People's Hospital
- E-Mail: 136166618@qq.com
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Jiangxi
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Fuzhou, Jiangxi, China
- Fuzhou First People's Hospital
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Kontakt:
- Fuzhou First People's Hospital
- E-Mail: yaoguojun1981@163.com
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Shandong
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Jinan, Shandong, China
- Jinan Central Hospital
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Kontakt:
- Song Li
- Telefonnummer: +8618761196261
- E-Mail: doctorlisong@126.com
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Zhejiang
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Taizhou, Zhejiang, China
- Taizhou Hospital of Zhejiang Province
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Kontakt:
- Zhixin Zhao
- Telefonnummer: +8617280677109
- E-Mail: caiyj10982@enzemed.com
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Beschreibung
Inclusion Criteria:
- Aged 18-85 years, of either sex.
- First-ever intracerebral hemorrhage (ICH) with CT-confirmed hemorrhage involving the third and/or fourth ventricle, and scheduled to undergo or already having undergone burr-hole ventricular drainage.
- Intraparenchymal hemorrhage volume <30 mL on admission CT, with stable neurological status and no progressive deterioration before randomization.
- Randomization completed within 72 hours of symptom onset.
- Pre-onset modified Rankin Scale (mRS) score of 0 (no symptoms) or 1 (minor symptoms not interfering with daily activities).
- Written informed consent obtained from the participant or a legal guardian.
Exclusion Criteria:
- Secondary intracerebral hemorrhage, including imaging-confirmed untreated intracranial arteriovenous malformation (AVM), ruptured intracranial aneurysm, moyamoya disease, or intracranial tumor.
- Long-term use of anticoagulant medication, persistent coagulopathy, or known allergy to urokinase.
- Prothrombin time (PT) or activated partial thromboplastin time (APTT) prolonged to more than twice the upper limit of normal.
- Absolute contraindications to lumbar or external ventricular drainage (e.g., cerebral herniation, infection at the puncture site).
- Infratentorial hemorrhage with a volume ≥10 mL.
- Thalamic hemorrhage with a volume ≥10 mL, or accompanied by obvious extension into the midbrain, oculomotor nerve palsy, or fixed and dilated non-reactive pupils.
- Unilateral limb paralysis (muscle strength grade 0 or 1) before randomization.
- Active bleeding from other sites, including the gastrointestinal, genitourinary, or respiratory tracts.
- Multiple superficial ecchymoses, purpura, or other signs suggesting bleeding or a bleeding tendency.
- Expected survival of less than 6 months due to other causes.
- Other coexisting severe diseases that are difficult to treat.
- Pregnancy.
- Participation in another interventional clinical trial within 30 days before randomization.
- Any other condition that, in the investigator's judgment, makes the participant unsuitable for the study.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Keine (Offenes Etikett)
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
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Aktiver Komparator: Control Group (EVD + Intrathecal Urokinase)
Patients received external ventricular drainage (EVD) combined with intrathecal urokinase injection.
Urokinase was administered as a single daily dose of 30,000 IU for 3 consecutive days.
A follow-up cranial CT was then performed to assess ventricular obstruction and hematoma clearance, which guided the decision on whether to continue thrombolysis.
The maximum total duration of urokinase treatment did not exceed 5 days.
Thrombolysis was discontinued when CT demonstrated clearance of the third/fourth ventricular cast, relief of mass effect, or a hematoma clearance rate of ≥80%.
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Patients receive external ventricular drainage (EVD) combined with intrathecal urokinase injection.
Urokinase is administered as a single daily dose of 30,000 IU for 3 consecutive days, and the maximum duration of urokinase treatment does not exceed 5 days.
Thrombolysis is discontinued when cranial CT demonstrates clearance of the third/fourth ventricular cast, relief of mass effect, or a hematoma clearance rate of ≥80%.
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Experimental: Intervention Group (Control Treatment + Lumbar Drainage)
In addition to the same EVD and intrathecal urokinase regimen as the control group, early lumbar drainage was initiated within 72 hours of onset.
The CSF drainage rate was maintained below 8 mL/h, and the daily total drainage volume did not exceed 200 mL to maintain stable intracranial pressure.
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Early lumbar cistern drainage was initiated within 72 hours of onset.
The CSF drainage rate was maintained below 8 mL/h, and the daily total drainage volume did not exceed 200 mL to maintain stable intracranial pressure.
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Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Proportion of participants with mRS score 0-3 at 180 days after onset
Zeitfenster: 180 days after disease onset
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Percentage of patients with modified Rankin Scale score 0 to 3 at 180-day follow-up.
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180 days after disease onset
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Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Proportion of participants with mRS 0-3 at 90 days after onset
Zeitfenster: 90 days after onset
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Percentage of patients with a modified Rankin Scale score of 0 to 3 at the 90-day follow-up.
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90 days after onset
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Proportion of participants with GOS score 4-5 at 180 days after onset
Zeitfenster: 180 days after onset
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Percentage of patients with a Glasgow Outcome Scale (GOS) score of 4 or 5 at the 180-day follow-up.
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180 days after onset
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Proportion of participants with mRS 0-2 at 90 days and 180 days
Zeitfenster: 90 and 180 days after disease onset
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Percentage of patients with a modified Rankin Scale score of 0 to 2 at the 90- and 180-day follow-up.
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90 and 180 days after disease onset
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Change in ordinal mRS score from baseline to 180 days after onset
Zeitfenster: Baseline to 180 days after disease onset
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Change in the ordinal modified Rankin Scale score between baseline and the 180-day follow-up.
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Baseline to 180 days after disease onset
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EQ-5D score at 180 days after onset
Zeitfenster: 180 days after disease onset
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Health-related quality of life measured by the EuroQol-5D (EQ-5D) questionnaire at the 180-day follow-up.
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180 days after disease onset
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Proportion of participants with Barthel Index score 75-100 at 180 days after onset
Zeitfenster: 180 days after disease onset
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Percentage of patients with a Barthel Index score of 75 to 100 at the 180-day follow-up.
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180 days after disease onset
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Proportion of participants with shunt-dependent hydrocephalus before discharge and at 180 days after onset
Zeitfenster: Before hospital discharge and 180 days after disease onset
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Percentage of patients requiring permanent cerebrospinal fluid shunting for hydrocephalus before hospital discharge and at the 180-day follow-up.
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Before hospital discharge and 180 days after disease onset
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Daily CSF drainage volume before catheter removal
Zeitfenster: During the drainage period before catheter removal
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Daily volume of cerebrospinal fluid drained (mL/day) from the external ventricular drain and lumbar drain before removal of the drainage catheters.
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During the drainage period before catheter removal
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Proportion of participants with resolution of third and/or fourth ventricular obstruction
Zeitfenster: Within 14 days after enrollment or before hospital discharge
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Percentage of patients with resolution of third and/or fourth ventricular obstruction on cranial CT within 14 days after enrollment or before hospital discharge.
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Within 14 days after enrollment or before hospital discharge
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Dynamic intracranial hemorrhage clearance rate before catheter removal
Zeitfenster: Before removal of the external ventricular and lumbar drainage catheters
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Serial (dynamic) rate of intracranial hemorrhage clearance on cranial CT before removal of the external ventricular and lumbar drainage catheters.
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Before removal of the external ventricular and lumbar drainage catheters
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Length of hospital stay
Zeitfenster: From admission to hospital discharge
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Total duration of hospitalization (days).
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From admission to hospital discharge
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Length of NICU stay
Zeitfenster: From NICU admission to NICU discharge
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Total duration of stay in the intensive care unit (days).
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From NICU admission to NICU discharge
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Total hospitalization costs
Zeitfenster: From admission to hospital discharge
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Total medical costs incurred during hospitalization, in RMB.
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From admission to hospital discharge
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Andere Ergebnismessungen
Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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All-cause mortality at 180 days after onset
Zeitfenster: 180 days after disease onset
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Percentage of patients who died from any cause by the 180-day follow-up.
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180 days after disease onset
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Proportion of participants with intracranial infection
Zeitfenster: From enrollment through hospital discharge
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Percentage of patients who developed intracranial infection during the study period.
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From enrollment through hospital discharge
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Proportion of participants with cerebral herniation
Zeitfenster: From enrollment through hospital discharge
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Percentage of patients who developed cerebral herniation.
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From enrollment through hospital discharge
|
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Proportion of participants with symptomatic rebleeding within 72 hours after catheter placement or thrombolysis
Zeitfenster: Within 72 hours after catheter placement or thrombolysis
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Percentage of patients with symptomatic intracranial rebleeding within 72 hours after catheter placement or intrathecal thrombolysis.
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Within 72 hours after catheter placement or thrombolysis
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Proportion of participants with other serious adverse events
Zeitfenster: From enrollment through the 180-day follow-up
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Percentage of patients who experienced other serious adverse events during the study period.
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From enrollment through the 180-day follow-up
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Mitarbeiter und Ermittler
Sponsor
Sponsor
Mitarbeiter
Mitarbeiter
Ermittler
Ermittler
- Hauptermittler: Shigang Lv, MD, Second Affiliated Hospital of Nanchang University
- Hauptermittler: Miaojing Wu, MD, Second Affiliated Hospital of Nanchang University
- Hauptermittler: Zeguang Ren, Prof, Methodist Houston Sugar Land Hospital
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Geschätzt)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- LD-IVH-2026-001
- ChiCTR2600123877 (Registrierungskennung: Chinese Clinical Trial Registry (ChiCTR))
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