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PubMed · 12795039

Neuroprotection for ischemic stroke.

Janice L Hinkle·Lisa Bowman
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Abstract

Many pharmacological and nonpharmacologic neuroprotective therapies are in various phases of animal or human testing. The future in acute ischemic stroke therapy most likely will consist of combination therapies (Bonnono et al., 2000; Schellinger et al., 2001). An IV thrombolytic agent may be combined with an IA agent and then followed up with a neuroprotective strategy early in treatment of acute ischemic stroke. A hemicraniectomy may be combined with hypothermia to improve outcome (Georgiadis et al., 2002). Many resources (Fig 2) are available to assist neuroscience nurses in keeping abreast of this fast-paced area of development.

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Brain IschemiaCalcium Channel BlockersEducation, Nursing, ContinuingFibrinolytic AgentsFree Radical ScavengersGABA AgonistsHumansStrokeJournal ArticleReview

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Janice L Hinkle, Lisa Bowman. 2003. Neuroprotection for ischemic stroke.. https://doi.org/10.1097/01376517-200304000-00008

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Hemorrhagic complications after off-label thrombolysis for ischemic stroke.

BACKGROUND AND PURPOSE: Only 2% to 4% of patients with acute ischemic stroke receive thrombolytic therapy resulting from the current strict inclusion criteria among other issues. Safety of intravenous and intraarterial thrombolysis in off-label situations is controversially discussed. We sought to review the reports on such patients regarding intra- and extracranial hemorrhage. SUMMARY OF REVIEW: A MEDLINE search for off-label uses of thrombolysis revealed reports on 273 patients treated with intraarterial or intravenous thrombolysis for ischemic stroke. Symptomatic intracranial hemorrhage occurred in 19 of 273 patients (6.95%) and extracranial hemorrhage in 17 of 273 (6.22%). CONCLUSIONS: These data suggest that the overall bleeding risk in off-label thrombolysis may not be as high as presumed. However, the small number of patients in each group and the likely underreporting of worse outcomes preclude drawing any conclusion as to specific treatment recommendations. Selected patients might benefit, however, from thrombolysis in situations not currently considered in the inclusion criteria. To obtain a meaningful database, a registry for off-label thrombolysis should be created.

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