Background. - Intraventricular hemorrhage (IVH) is a severe form of stroke. Studies of existing treatment options are controversial. Therefore, we aimed to evaluate the safety and efficacy of extra ventricular drainage (EVD) combined with uPA administration for the treatment of IVH. Methods. - The clinical data of 157 IVH patients admitted to our department during 2019-2022 were retro-spectively analyzed. Based on the Glasgow Outcome Score (GOS) after 30 days, patients were categorized into favorable outcome (GOS4-5) and poor outcome (GOS1-3), and factors with prognostic impact were screened by univariate and multifactorial analysis, followed by propensity score matching and screening of paired patients for comparative analysis between the uPA and non-uPA groups. Results. - Patient age, uPA use, initial GCS score, and intracranial hematoma volume can all influence the patient's GOS. After propensity score-matched screening, 72 patients were finally included, 36 each in the uPA and non-uPA groups. Analysis revealed that at the follow-up after 30 days, 50.0% of patients with a GOS score of 4-5 were in the uPA group compared with 30.6% in the non-uPA group; however, they were not statistically significantly different. In contrast, the mean clearance of hematoma after four days was significantly higher in the uPA group than in the non-uPA group (P < 0.05) and did not increase the incidence of postoperative complications (P > 0.05). Conclusion. - uPA treatment may eliminate hematomas faster and reduce the rate of obstruction. However, its effectiveness in improving patient prognosis does not appear to be significant. Therefore, studies with larger samples may be needed to further validate its effectiveness.(c) 2022 Elsevier Masson SAS. All rights reserved.