title: Pharmacological Management Options to Prevent and Reduce Ischemic Hemorrhagic Transformation.
abstract: BACKGROUND
  Hemorrhagic transformation (HT) is a common and natural complication after acute ischemic stroke. The only FDA-approved treatment so far for acute ischemic stroke is rapid reperfusion with recombinant tissue plasminogen activator (rtPA). Although it has been shown to exaggerate the risk and severity of HT and to be associated with increased morbidity and mortality.
  
  
  OBJECTIVE
  The aim of this review is to discuss the multifactorial pathophysiology of hemorrhagic transformation, promising interventional targets, and pharmacological treatment options.
  
  
  CONCLUSIONS
  Understanding HT is essential to restore cerebral blood flow to ischemic brain by reperfusion therapy without causing this complication and additional brain injury. Therefore methods for the prevention and treatment of HT are needed. Although experimental studies showed promising results, clinical translation remains unsatisfactory to date.
authors.affiliation: Department of Physiology and Pharmacology, Loma Linda University Medical Center, Loma Linda, USA.
authors.forename: Wing Mann
authors.initials: WM
authors.lastname: Ho
authors.affiliation: Department of Physiology and Pharmacology, Loma Linda University Medical Center, Loma Linda, USA.
authors.forename: Cesar
authors.initials: C
authors.lastname: Reis
authors.affiliation: Department of Physiology and Pharmacology, Loma Linda University Medical Center, Loma Linda, USA.
authors.forename: Onat
authors.initials: O
authors.lastname: Akyol
authors.affiliation: Department of Physiology and Pharmacology, Loma Linda University Medical Center, Loma Linda, USA.
authors.forename: Gokce Yilmaz
authors.initials: GY
authors.lastname: Akyol
authors.affiliation: Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Applegate
authors.affiliation: Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Stier
authors.affiliation: Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Martin
authors.affiliation: Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Room 2562B, Loma Linda, CA 92354, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Zhang
mesh_terms: D000818:Animals; D002545:Brain Ischemia / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism; D002543:Cerebral Hemorrhage / Q000378:metabolism / Q000517:prevention & control*; D004195:Disease Models, Animal; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D020782:Matrix Metalloproteinases / Q000378:metabolism; D017382:Reactive Oxygen Species / Q000378:metabolism; D015398:Signal Transduction / Q000187:drug effects; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D005343:Fibrinolytic Agents; D017382:Reactive Oxygen Species; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D020782:Matrix Metalloproteinases
keywords: Cerebral ischemia; conversion; hemorrhagic transformation; prevention; stroke; treatment