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Thrombolytic therapy for acute ischemic stroke.

C Cornu1, E Amsallem, A Serradj-Jaillard A

  • 1Service de Pharmacologie Clinique EA 643, Claude Bernard University, Lyon, France. Catherine.Cornu@chu-lyon.fr

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|January 20, 2004
PubMed
Summary

Thrombolytic therapy for acute ischemic stroke shows mixed results. Alteplase offers some benefit but requires better patient selection criteria, while streptokinase is harmful and should not be used.

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Thrombolytic therapy is a critical treatment for acute ischemic stroke.
  • Recent trials and meta-analyses provide evolving evidence on its efficacy and tolerability.

Purpose of the Study:

  • To review the literature on thrombolytic therapy for acute ischemic stroke.
  • To assess the level of evidence for different thrombolytic drugs.
  • To guide routine clinical practice based on current evidence.

Main Methods:

  • Bibliographic search of published meta-analyses and randomized trials (published and ongoing).
  • Outcomes assessed include disability, death, and symptomatic intracerebral hemorrhage.
  • Primary endpoint: combination of death or dependency (modified Rankin Score >/=3).

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Main Results:

  • Streptokinase is harmful and should not be used in acute ischemic stroke.
  • Intra-arterial pro-urokinase has low-level evidence of efficacy; use is not justified.
  • Alteplase shows a beneficial effect but with significant heterogeneity and increased mortality in some trials; patient selection criteria are lacking.

Conclusions:

  • Streptokinase is contraindicated for acute ischemic stroke.
  • Current evidence for pro-urokinase is insufficient for clinical use.
  • Alteplase demonstrates benefit but requires further research for optimal patient selection to maximize efficacy and minimize risks.