[Pharmacotherapy of stroke]

Annually about 50,000 patients are hospitalized for acute stroke in Hungary. Of all stroke cases 85% are ischemic, and 15% are hemorrhagic (intracerebral or subarachnoid). In acute ischemic stroke the only registered causal treatment with proven efficacy is thrombolysis with intravenous administration of recombinant tissue plasminogen activator with a 3-hour time window. The indication areas of intraarterial thrombolysis are currently being established for selected cases in selected centers. Other studies examine the options to extend the time window and to test new thrombolytic agents. Despite the large number of studies none of the neuroprotectant agents have been found beneficial in randomized controlled clinical trials in acute stroke. According to the results of studies to date anticoagulant therapy (heparin) cannot be recommended for the routine treatment of acute stroke. Aspirin may be safely administered within 48 hours of ischemic stroke and results in a 1% decrease of death or disability at 6 months after stroke. There were no large studies on the use of other antiplatelet agents in acute stroke. If thrombolysis is performed, antiplatelet or anticoagulant agents should not be administered in the first 24 hours. Further studies are needed to test the efficacy and safety of anticoagulants in special cases of stroke (e.g. crescendo TIA-s, progressing stroke), and to test combined antiplatelet treatment in the acute phase of stroke. In acute intracerebral hemorrhage the beneficial effect of recombinant coagulation factor VII found in a small study could not be proved in a large phase III trial. Currently there is no evidence based pharmacotherapy for the specific treatment of intracerebral hemorrhage. In subarachnoid hemorrhage nimodipine was found effective in preventing vasospasm and thus secondary ischemic cerebral damage. Although the results of individual trials are conflicting, a systematic review on the effects of statins suggests a similar effect. Due to the limited options of evidence based treatments of acute stroke primary prevention has utmost importance.