Tissue plasminogen activator for acute ischemic stroke

Article Abstract:

Patients treated with intravenous t-PA within three hours of the onset of acute ischemic stroke appear to have beneficial outcomes. Researchers tested tissue plasminogen activator (t-PA) for clinical activity 24 hours after stroke onset in 291 patients in part 1 of the trial, and evaluated 333 patients given t-PA within three hours of ischemic stroke for clinical outcome at three months in part 2. Patients treated with t-PA were 30% more likely to have little or no disability on assessment scales after three months compared to the patients given placebo. No specific differences were noted in patients given t-PA and placebo in the first 24 hours. A negative effect of t-PA was the increased incidence of symptomatic intracranial hemorrhage among patients given the drug, although the patients affected had more serious neurological problems at initial evaluation. Three-month mortality was 21% in a placebo group and 17% in the t-PA group.

Cerebral ischemia

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Low-molecular-weight heparin for the treatment of acute ischemic stroke

Article Abstract:

Patients with acute ischemic stroke appear to benefit from the treatment with low-molecular-weight heparin given as nadroparin within 48 hours of the onset of symptoms. Researchers studied 306 Chinese patients who were randomly given a high-dose regimen of 4100 anti-factor Xa IU of nadroparin twice a day, a low-dose regimen of 4100 anti-factor Xa IU of nadroparin once a day, or placebo, under the skin for 10 days. At six months, a total of 45 patients in the high-dose group, 53 in the low-dose group, and 68 in the placebo group became dependent on others for daily living or died. At a six-month follow up, the patients given the high dosage of nadroparin fared significantly better than patients given placebo. One death or case of dependency on others could be averted by the use of the high-dose nadroparin regimen in five patients.

Heparin

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t-PA - the best current option for most patients

Article Abstract:

Recombinant tissue plasminogen activator (t-PA) should be offered to most stroke patients but strict protocols should be developed and followed. This drug is a thrombolytic drug that breaks up blood clots in the brain that cause most strokes. However, it can also increase the risk of bleeding in the brain. The FDA approved this drug for stroke patients after one large study found that 17% of the patients given the drug made a complete recovery within 24 hours. The drug reduced the rate of severe disability as well as the hospital stay and overall health care costs.

Fibrinolytic agents, Thrombolytic drugs

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