Thepairinja Stroke 4

Stroke 4
CVM Focus Journal (2009)
There have been studies aiming to identify a window period of giving thrombolytic agents to improve blood flow of the penumbra zone of patients with acute ischemic stroke. The DIAS (Desmoteplase in Acute Ischemic Stroke) and DEDAS (Dose Escalation of Desmoteplase for Acute Ischemic Stroke) trials evaluating safety and efficacy of giving desmoteplase during 3-9 hours after the onset of acute ischemic stroke suggested benefits of the drug. The researchers found that dose escalation of desmoteplase up to 125 mcg/kg resulted in higher reperfusion rates and better recovery than those of placebo-treated patients. Besides, desmoteplase did not increase incidence of intracerebral hemorrhage.
To prevent such hemorrhage, the American Stroke Association recommends keeping the patient's blood pressure (BP) at 160/90 mmHg. In an acute phase, we have to give intravenous antihypertensive agents and closely monitor BP. The recommended antihypertensive drug in Thailand is nicardipine. In addition, sodium nitroprusside with vasodilation effects on both arteries and veins could increase intracranial pressure. Thus, it should be used only in case of very high BP or shortage of better antihypertensive agents.
Referring to treatment for intracerebral hemorrhage, a phase II study providing recombinant activated factor VII (rFVIIa) for those with the hemorrhage within four hours revealed that the drug helped prevent expansion of the clots. Unfortunately, at three months there was no significant difference in
mortality and morbidity rates among those receiving placebo, rFVIIa at 20 mcg/kg, and rFVIIa at 80 mcg/kg.

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