[Efficacy and safety of treatment of acute ischemic stroke with glycoprotein IIb/IIIa receptor blocker in routine clinical practice].
BACKGROUND
Platelet aggregation plays an important pathophysiological role in the incidence of myocardial infarction and ischemic stroke. The expression of glycoprotein IIb/IIIa receptors on the surface of activated platelets is the final common pathway of platelet aggregation.


METHODS
Encouraged by the favorable outcome in acute coronary syndromes and by preliminary results, which substantiate the efficacy and safety of GP IIa/III antagonists (GP) in ischemic stroke, we treated 21 cases/20 patients (13 male, 7 female, age 39-79 y.) and conducted a retrospective study using a clinical graduation scale (Modified Rankin Scale MRS). Patients received tirofiban (n = 18) or eptifibatide (n = 3) in the usual cardiological dose 3 h (0.5-8 h) after beginning of symptoms together with "full dose " heparin (n = 8) or "low dose" heparin (n = 12) in the acute phase, with aspirin 100 mg (n = 4), Clopidrogel 75 mg (n = 5), aspirin + clopidogrel (n = 4) in the chronic phase. All patients had a cranial CT, 95% an echocardiography and Doppler sonography of the carotid artery system and some cranial MRI (43%).


RESULTS
There was no significant clinical deterioration. All except one patient showed a rapid and impressive improvement during the first 24 h after initiation of treatment (median MRS pre/post 3/1).


CONCLUSIONS
The results with GP in acute ischemic stroke are promising and further studies should be initiated using especially tirofiban, but with monitoring by cerebral diffusion-weighted MRI before and after treatment.
Haerten
K
K
Marien-Hospital, Klinik für Innere Medizin I, Kardiologie-Angiologie-Pneumologie, Wesel. klaus.haerten@marien-hospital-wesel.de
Krabbe
Chr
C
Raiber
M
M
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D002545:Brain Ischemia / Q000188:drug therapy*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D000077542:Eptifibatide; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077466:Tirofiban; D014057:Tomography, X-Ray Computed; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018608:Ultrasonography, Doppler
D000925:Anticoagulants; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D006493:Heparin; D000077144:Clopidogrel; D000077466:Tirofiban; D000077542:Eptifibatide; D013988:Ticlopidine; D001241:Aspirin