title: Considering hyperglycemia and thrombolysis in the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial.
abstract: Hyperglycemia is associated with enhanced cortical toxicity and larger infarct volumes following focal cerebral ischemia. Initial blood glucose in acute ischemic stroke patients may also contribute to a differential response to thrombolysis (i.e., administration of tissue plasminogen activator (t-PA)) and affect risk of symptomatic intracerebral hemorrhage (sICH). The Stroke Hyperglycemia Insulin Network Effort (SHINE) study is a phase III single-blinded, randomized control trial comparing an intensive level of glucose control with standard of care glucose control in hyperglycemic stroke patients. In stratifying randomization by treatment with intravenous t-PA, the SHINE trial offers a unique opportunity to evaluate an association between euglycemic control and outcomes from stroke thrombolysis in a prospective, comparative study. We hypothesize that normalization of blood glucose in the acute stroke setting may reduce risk of thrombolysis-induced sICH. With enrollment recently underway, the stratified results from the SHINE trial could substantially influence future treatment decisions for hyperglycemic stroke patients.
authors.affiliation: Division of Vascular Neurology, Department of Neurology, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Southerland
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnston
mesh_terms: D000818:Animals; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000517:prevention & control; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy; D004195:Disease Models, Animal; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D007262:Infusions, Intravenous; D007328:Insulin / Q000627:therapeutic use*; D009249:NADP / Q000378:metabolism; D019255:NADPH Oxidases / Q000378:metabolism; D009765:Obesity / Q000150:complications; D011994:Recombinant Proteins / Q000627:therapeutic use; D016037:Single-Blind Method; D013481:Superoxides / Q000378:metabolism; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D007328:Insulin; D011994:Recombinant Proteins; D013481:Superoxides; D009249:NADP; D019255:NADPH Oxidases; D010959:Tissue Plasminogen Activator