Antithrombotic Therapy in Acute Ischemic Stroke.
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Accession number;02A0514994
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| Title;Antithrombotic Therapy in Acute Ischemic Stroke. |
| Author;
UCHIYAMA SHIN'ICHIRO
(Tokyo Women's Medical College, Neurological Inst.)
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Journal Title;Prog Med
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Journal Code:F0664B
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ISSN:0287-3648
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VOL.22;NO.5;PAGE.1157-1162(2002)
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| Figure&Table&Reference;FIG.3, REF.23 |
| Pub. Country;Japan |
| Language;Japanese |
| Abstract;According to a meta-analysis by the Cochrane Stroke Group (CSG) on 17 randomized controlled trials (RCTs) of thrombolytic therapy including 5,216 patients with acute ischemic stroke (AIS), the trials tested urokinase, streptokinase, recombinant tissue plasminogen activator (tPA) or pro-urokinase, and thrombolytic therapy increased deaths within the first seven to 10 days and deaths at final follow-up as well as symptomatic and fatal intracranial hemorrhage, while these risks are offset by a reduction in disability in survivors, so that there is overall a significant net reduction in the proportion of patients dead or dependent. Trials testing intravenous (IV) tPA suggest that it may be associated with less hazard and more benefit. The data may justify the the use of thrombolytic therapy with IV tPA in experienced centers in selected patients. Intra-arterial pro-urokinase also showed to improve outcome at 3 months in patients with M 1 or M 2 occlusion within 6 hours of onset in one trial conducted recently. A RCT of intra-arterial urokinase in patients with abrupt onset of stroke with M 1 or M 2 occlusion and without obvious early CT signs is ongoing in Japan. An international trial of desmoteplase, a third generation of thromblytic agent, is currently ongoing in patients with AIS within 3 to 6 hours of onset. In a meta-analysis by CSG, 21 RCTs involving 23,427 patients with AIS were included for comparing early anticoagulant therapy started within two weeks of stroke onset with control. The anticoagulants tested were unfractionated and low-molecular-weight heparins, heparinoids, oral anticoagulants, and thrombin inhibitors. Immediate anticoagulant therapy in patients with AIS was not associated with net short or long-term benefit because there was no evidence that anticoagulant therapy reduced the odds of death from all causes or those of being dead or dependent at the end of follow-up.... (author abst.) |
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