Intraventricular haemorrhage carries a high risk of mortality and severe disability, and the CLEAR III trial set out to examine whether thrombolytic removal of the haemorrhage could improve patient outcomes. In this placebo-controlled trial, 500 patients with intraventicular haemorrhage were randomly assigned to ventricular irrigation with either alteplase or saline. Although the alteplase treatment resulted in a reduction in case fatality, most of the additional survivors had poor functional outcomes, indicating that this approach has little net benefit.