Thrombolysis in stroke.
The ability to use an effective treatment constitutes a main concern in the management of acute ischemic stroke. Randomized trials have so far failed to demonstrate any beneficial effect of neuroprotective agents on neurologic outcome after an acute stroke. Thrombolytic agents can achieve early recanalization of an occluded intracerebral artery. The benefit of their use in ischemic stroke has been assessed in several randomized trials involving more than 5,000 patients. Among them, a single randomized trial, the National Institute of Neurological Diseases and Stroke Trial, showed a beneficial effect of thrombolysis on outcome after an acute ischemic stroke with a significant increase in the number of patients with no or minimal disability at 3 months in the group receiving intravenous recombinant tissue plasminogen activator (rt-PA) compared with placebo. However, there was no reduction in mortality and there was, as in all other trials, a significant increase in the risk of symptomatic intracerebral hemorrhage (ICH).
Vahedi
Katayoun
K
Service de Neurologie, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiére, Faculté de Médecine Lariboisiére, Paris, France. katayoun@vahedi@lrb.ap-hop-paris.fr
Bousser
Marie-Germaine
MG
D000208:Acute Disease; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013300:Streptokinase / Q000627:therapeutic use; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator