title: [Intravenous thrombolysis in ischemic stroke: Therapeutic perspectives].
abstract: New therapeutic strategies are under evaluation to improve the treatment of acute ischemic stroke (AIS). Approaches combining intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) and antithrombotic agents are currently evaluated. The combination of IV rt-PA and aspirin showed a high rate of intracranial hemorrhage whereas the association of rt-PA and eptifibatide seems more promising. The results of recent studies evaluating the administration of eptifibatide or argatroban in conjunction with conventional IV thrombolysis with rt-PA are expected to clarify the safety and efficacy of these treatments. More fibrin-specific plasminogen activators, tenecteplase and desmoteplase, are also investigated. These fibrinolytic agents showed a favorable safety profile but their efficacy in AIS remains uncertain. While phase III studies, DIAS-3 and DIAS-4, evaluating IV desmoteplase up to nine hours after stroke onset did not meet the primary endpoint, the results of studies comparing IV tenecteplase and IV rt-PA are expected.
authors.affiliation: Faculté de pharmacie de Lyon, 8, avenue Rockefeller, 69373 Lyon cedex 08, France.
authors.forename: C
authors.initials: C
authors.lastname: Paris
authors.affiliation: Unité neurovasculaire, service de neurologie, hôpital neurologique de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France. Electronic address: laurent.derex@chu-lyon.fr.
authors.forename: L
authors.initials: L
authors.lastname: Derex
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D010960:Plasminogen Activators / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy*; D000077785:Tenecteplase; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; C069588:salivary plasminogen activator alpha 1, Desmodus rotundus; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase
keywords: Antithrombotics; Antithrombotiques; Desmoteplase; Desmotéplase; Infarctus cérébraux; Ischemic stroke; Tenecteplase; Thrombolyse; Thrombolysis; Ténectéplase