מתוך medicontext.co.il
By Michelle Beaulieu Cooke
WESTPORT, CT (Reuters Health) – Stroke patients with blood glucose above 200 mg/dL have a more than fourfold increased risk of intracerebral hemorrhage (ICH) after intra-arterial thrombolysis for ischemic stroke, according to researchers in the US and Canada.
"Intracerebral hemorrhage is more common after intra-arterial thrombolysis than after intravenous thrombolysis," study director, Dr. Carlos S. Kase, told Reuters Health. Despite this finding, he believes that "intra-arterial thrombolysis benefits patients with…occlusion of the middle cerebral artery."
Dr. Kase, of Boston University School of Medicine, and multicenter colleagues examined predictors of ICH in 174 ischemic stroke patients enrolled in a clinical trial (PROACT II) of recombinant pro-urokinase. Of the patients, 110 were randomized to 9 mg intra-arterial pro-urokinase over 120 minutes plus a fixed intravenous dose of heparin, and the remainder received intravenous heparin alone.
Patients treated with intra-arterial pro-urokinase were more likely to develop ICH following treatment than were those treated with heparin alone (10.9% versus 3.1%, respectively), however this difference was not statistically significant.
What was significant, however, was a 4.2-fold increase in the risk of ICH among patients in the pro-urokinase group who had >200 mg/dL blood glucose at baseline compared with those with lower glucose levels (p = 0.022), according to the report in the November 13th issue of Neurology.
In general, ICH symptoms presented approximately 10.2 hours after treatment initiation. Overall, mortality was high in patients with ICH, occurring in 10 of 12 patients (83%).
The authors note that, because the ICHs in this group of patients all occurred in the area of the ischemic infarct (middle cerebral artery), "local vascular factors, probably related to an abnormal permeability of the blood-brain barrier or to other mechanisms of ischemic vascular injury, [likely] played a role in their pathogenesis."
"The ICHs after intra-arterial thrombolysis are severe, and thus the best approach to them is their prevention," Dr. Kase explained in an interview. One way to prevent ICH would be to identify early those at greatest risk, such as patients with elevated blood sugar at presentation and those with severe strokes, as measured by the NIH Stroke Scale.
Prevention could also include "a more active approach to the management of hyperglycemia before the administration of thrombolytic agents," the authors write. However, recommendation of this approach awaits confirmation of the findings in larger trials.
e-Med Tools
קצר קולע וממוקד
e-Med סמינרים
אי-מד תחקירים
Medscape Tools
Journal Club
מרכזי מידע ושירות
Facebook
מידע למפרסם
מאגר תרופות
מאגר אנשי המקצוע
אינדקס שימושי
חדשות משה"ב
eMed HealthClub
מחקרים קליניים
השאירו תגובה
רוצה להצטרף לדיון?תרגישו חופשי לתרום!