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Drug Treatment of Acute Ischemic Stroke

  • Therapy in Practice
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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.

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Acknowledgments

NIH/NINDS grant K23 NS 059843.

Financial Disclosures:

SB: None.

KSS: None.

PK: Research Support (NIH, Penumbra, Inc as Neurology PI of THERAPY Trial), Travel Support (Genentech, Inc. as unpaid consultant), Consultant Fees (medical expert in medicolegal cases).

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Authors and Affiliations

  1. Visiting Student, Department of Neurology, University of Cincinnati, College of Medicine, Cincinnati, OH, USA

    Sameer Bansal

  2. Clinical Pharmacy Specialist – CNS, UC Health University Hospital, University of Cincinnati, College of Pharmacy, Cincinnati, OH, USA

    Kiranpal S. Sangha

  3. Department of Neurology, University of Cincinnati, College of Medicine, 260 Stetson St, Ste 2300, ML 0525, Cincinnati, OH, 45267-0525, USA

    Pooja Khatri

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  1. Sameer Bansal
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Correspondence to Pooja Khatri.

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Bansal, S., Sangha, K.S. & Khatri, P. Drug Treatment of Acute Ischemic Stroke. Am J Cardiovasc Drugs 13, 57–69 (2013). https://doi.org/10.1007/s40256-013-0007-6

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