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- Title
Drug Treatment of Acute Ischemic Stroke.
- Authors
Bansal, Sameer; Sangha, Kiranpal; Khatri, Pooja
- Abstract
Acute ischemic stroke (AIS) is the fourth leading cause of death and the leading cause of adult disability in the USA. AIS most commonly occurs when a blood vessel is obstructed leading to irreversible brain injury and subsequent focal neurologic deficits. Drug treatment of AIS involves intravenous thrombolysis with alteplase (recombinant tissue plasminogen activator [rtPA]). Intravenous alteplase promotes thrombolysis by hydrolyzing plasminogen to form the proteolytic enzyme plasmin. Plasmin targets the blood clot with limited systemic thrombolytic effects. Alteplase must be administered within a short time window to appropriate patients to optimize its therapeutic efficacy. Recent trials have shown this time window may be extended from 3 to 4.5 hours in select patients. Other acute supportive interventions for AIS include maintaining normoglycemia, euthermia and treating severe hypertension. Urgent anticoagulation for AIS has generally not shown benefits that exceed the hemorrhage risks in the acute setting. Urgent antiplatelet use for AIS has limited benefits and should only promptly be initiated if alteplase was not administered, or after 24 hours if alteplase was administered. The majority of AIS patients do not receive thrombolytic therapy due to late arrival to emergency departments and currently there is a paucity of acute interventions for them. Ongoing clinical trials may lead to further medical breakthroughs to limit the damage inflicted by this devastating disease.
- Subjects
ASPIRIN; THERAPEUTIC use of fibrinolytic agents; HEPARIN; BENZIMIDAZOLES; DRUG therapy; WARFARIN; CLOPIDOGREL; PLATELET aggregation inhibitors; PYRIDINE; ENOXAPARIN; RIVAROXABAN; CEREBRAL ischemia; STROKE; THROMBOLYTIC therapy; THERAPEUTICS; TISSUE plasminogen activator
- Publication
American Journal of Cardiovascular Drugs, 2013, Vol 13, Issue 1, p57
- ISSN
1175-3277
- Publication type
Article
- DOI
10.1007/s40256-013-0007-6