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Thrombolytic therapy. From myocardial to cerebral infarction

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Abstract

Thrombolysis is proposed for the acute treatment of cerebral infarction as it is able to recanalize occluded arteries and thus potentially restore normal perfusion of the cerebral parenchyma, but the results concerning the efficacy of this treatment are still inconclusive. However, it has been fully demonstrated that thrombolytic treatment, leads to a significant reduction in mortality, in patients with acute myocardial infarction.

Data from all of the pilot studies using SK or rPA treatment in acute stroke are described in this review, which underlines the incidence of hemorrhagic transformation (hemorrhagic infart and parenchymal hematoma) and its possible correlation to clinical worsening.

Pharmacological, experimental and clinical studies encourage the carrying out of large-scale clinical trials using thrombolytics in patients with acute cerebral infarction.

Significant data relating to ongoing controlled clinical trials will be available in the near future; only after the analysis of these results will it be possible to confirm the efficacy of thrombolytics in acute stroke.

Sommario

La trombolisi è stata proposta nella fase acuta dell'infarto cerebrale quale terapia potenzialmente in grado di operare una ricanalizzazione arteriosa ed una conseguente riperfusione dell'area ischemica; ad oggi, però, i risultati degli studi eseguiti non permettono di provarne la reale efficacia. È già stato invece ampiamente dimostrato come il trattamento trombolitico determini una significantiva riduzione della mortalità nei pazienti colpiti da infarto miocardico acuto.

In questa revisione vengono esaminati i risultati degli studi pilota condotti su pazienti con ictus acuto trattati con Streptokinasi o tPA, mettendo in luce l'incidenza delle trasformazioni emorragiche (infarto emorragico ed ematoma intraparenchimale) correlate all'evoluzione clinica.

Gli studi farmacologici, sperimentali e clinici incoraggiano l'esecuzione di ampi studi con l'utilizzo della trombolisi anche in pazienti con infarto cerebrale.

Prossimamente conosceremo i risultati degli studi in via di completamento: solo l'analisi di quei dati ci permetterà di confermare la reale efficacia di questo trattamento.

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Authors and Affiliations

  1. Istituto di Clinica Neurologica, Università degli Studi di Milano, Via F. Sforza, 35, 20122, Milano, Italy

    Candelise L. MD, Aritzu E. & Ciccone A.

  2. Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy

    Roncaglioni C. & Maggioni A. P.

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  1. Candelise L. MD
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  2. Roncaglioni C.
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  3. Aritzu E.
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  5. Maggioni A. P.
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Candelise, L., Roncaglioni, C., Aritzu, E. et al. Thrombolytic therapy. From myocardial to cerebral infarction. Ital J Neuro Sci 17, 5–21 (1996). https://doi.org/10.1007/BF01995705

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