Antithrombotic Therapy of Acute Stroke: Thrombolytic Agents

It is nearly 40 years since the anticoagulant heparin was first used successfully in the treatment of thromboembolic disease. It is now appropriate to survey the enormous literature and clinical experience in an effort ot determine what effects antithrombotic therapy has had in the wide variety of conditions for which it has been used.This presentation will consist of an analysis ot determine where we are in this rapidly evolving field and to suggest directions for further study. It will include the status of heparin including mini-heparin, the coumarin derivatives, anti-platelet aggregating substances and thrombolytic agents.The indications for each will be listed and the unanswered questions will be stressed. The problems relating to standardization for the control of these types of therapy and the interaction with other drugs will be emphasized.

Download Full-text

Antithrombotic therapy in primary and secondary stroke prevention of cardiac patients and in acute stroke

Orvosi Hetilap ◽

10.1556/oh.2009.28414 ◽

2009 ◽

Vol 150 (5) ◽

pp. 195-202

Author(s):

László Csiba ◽

Katalin Réka Kovács

Keyword(s):

Acute Stroke ◽

Stroke Prevention ◽

Antithrombotic Therapy ◽

Cardiac Patients ◽

Secondary Stroke Prevention

A kardiogén stroke a jövőben egyre nagyobb jelentőségűvé válik gyakorisága növekedése miatt. Ischaemiás eseményt még nem szenvedett pitvarfibrilláló beteg esetén kockázatbecslést kell végezni és annak alapján dönteni a vérlemezkegátló vagy antikoaguláns kezelésről. (A legtöbb pitvarfibrilláló esetet antikoagulálni kell.) A pitvarfibrilláció súlyos stroke-kockázati tényező, ezért pitvarfibrilláló betegeknél az antikoagulálás a primer prevenció része (kivétel: fiatal, egyéb kockázati tényezővel nem rendelkező pitvarfibrilláló személy). Hetvenöt évnél idősebb pitvarfibrilláló beteg is antikoagulálható, megfelelően ellenőrzött INR-értékek mellett. A szerzők áttekintik az egyéb szívbetegségeket is, különös tekintettel a billentyűbetegségekre és a szívinfarktusra. Akut stroke-ban az új európai útmutató nem javasolja sem a hagyományos, sem a frakcionált heparin használatát. Ischaemiás stroke-ban aszpirinkezelést alkalmazunk az első három napban, és ezt követően térünk át tartós antikoaguláns kezelésre, és csak akkor, ha embóliaforrást tudtunk igazolni, illetve a beteg együttműködése megfelelő, a vérzésveszély viszonylag kicsi (INR 2-3). Egyébként csak vérlemezkegátló kezelést alkalmazunk. Néhány különleges esetben egyes szerzők javallják a korai antikoagulálást (az újabb embolizáció veszélye extrém nagy, bal pitvari/kamrai thrombus, artériadissectio vagy sebészi beavatkozás súlyos artériastenosis mellett), más esetben pedig óvatosságra intenek (kiterjedt infarktus, nem megfelelő módon kontrollálható vérnyomás, súlyos microvascularis elváltozások). A szekunder prevenció stádiumában nincs különbség a vérlemezkegátló és az antikoaguláns kezelés hatásossága között, elsősorban vérlemezkegátló kezelés jön szóba, kivéve azokat az eseteket, amikor a szív embóliaforrás.

Download Full-text

Safety of antithrombotic therapy for patients with acute ischemic stroke harboring unruptured intracranial aneurysm

International Journal of Stroke ◽

10.1177/1747493018765263 ◽

2018 ◽

Vol 13 (7) ◽

pp. 734-742 ◽

Cited By ~ 2

Author(s):

Yuji Shono ◽

Hiroshi Sugimori ◽

Ryu Matsuo ◽

Yoshihisa Fukushima ◽

Yoshinobu Wakisaka ◽

...

Keyword(s):

Ischemic Stroke ◽

Adverse Events ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Intracranial Hemorrhage ◽

Antithrombotic Therapy ◽

Intracranial Aneurysms ◽

Poor Functional Outcome ◽

Thrombolytic Agents ◽

Unruptured Intracranial Aneurysms

Background The safety of antithrombotic therapy for patients with acute ischemic stroke harboring unruptured intracranial aneurysms remains unclear. Aims This study was performed to determine whether treatment with antiplatelets, anticoagulants, or intravenous thrombolytic agents is safe for patients with acute ischemic stroke and unruptured intracranial aneurysms. Methods Among 9149 patients with acute ischemic stroke enrolled in the Fukuoka Stroke Registry from June 2007 to December 2014, 8857 patients with data on cerebrovascular imaging and three-month outcomes were included in this study. The frequency of adverse events, including intracranial hemorrhage, symptomatic intracranial hemorrhage, and in-hospital mortality, was compared between patients with and without unruptured intracranial aneurysms. The risk of a poor functional outcome (modified Rankin scale score of ≥3) at three months after stroke onset was estimated after adjusting for confounding factors by logistic regression analysis. Results Unruptured intracranial aneurysms were identified in 412 (4.7%) patients, and the mean diameter was 4.1 ± 3.2 mm. There was no significant difference in the frequency of any adverse events between patients with and without unruptured intracranial aneurysms among the overall patients or patients receiving antiplatelets, anticoagulants, or intravenous thrombolytic agents. The odds ratios of a poor functional outcome were not significantly higher in the presence of unruptured intracranial aneurysms, even in patients undergoing antiplatelet therapy, anticoagulation therapy, or intravenous thrombolysis. Conclusions These findings suggest that unruptured intracranial aneurysms are not associated with increased risks of adverse events or poor functional outcomes even after antithrombotic therapy for acute ischemic stroke. However, accumulation of cases is required to verify these findings.

Download Full-text

Rationale, Design and Methods of the Prospective Record of the Use of Dabigatran in Patients with Acute Stroke or TIA (PRODAST) Study

European Stroke Journal ◽

10.1177/23969873211060219 ◽

2021 ◽

pp. 239698732110602

Author(s):

Gerrit M. Grosse ◽

Christian Weimar ◽

Nils Kuklik ◽

Anika Hüsing ◽

Andreas Stang ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Stroke ◽

Antithrombotic Therapy ◽

Vitamin K Antagonists ◽

Optimal Time ◽

Optimal Timing ◽

Real World Data ◽

Index Event ◽

Increased Risk ◽

Design And Methods

Background The optimal timing of anticoagulation following acute ischaemic stroke or TIA in patients with atrial fibrillation (AF) is a frequent challenge. Early initiation of anticoagulation can reduce the risk for recurrent ischaemic events, but may lead to an increased risk for intracerebral haemorrhage. Aim The Prospective Record of the Use of Dabigatran in Patients with Acute Stroke or TIA (PRODAST) study was initiated to investigate outcome events under antithrombotic therapy after ischaemic stroke or TIA in patients with AF. The main objective is to compare the three-month rates of major haemorrhagic events between early (≤ 7 days) versus late (> 7 days) administration of dabigatran or treatment with vitamin-K antagonists started at any time. Occurrences of ischaemic and major haemorrhagic events will be evaluated to determine the optimal time point for initiation or resumption of anticoagulation. Design and Methods PRODAST is a prospective, multicenter, observational, non-interventional post-authorization safety study. 10,000 patients with recent (≤ 1 week from index event) ischaemic stroke or TIA and non-valvular AF were recruited at 86 German sites starting in July 2015. The observational plan includes a baseline visit, documentation of data during hospitalization and a telephone-based, central follow-up at three months after the index event. The primary endpoint is the major bleeding rate within three months. Secondary endpoints include rates of recurrent ischaemic or haemorrhagic stroke, TIA, systemic embolism, myocardial infarction and death. Summary PRODAST will provide important real-world data on safety and efficacy of antithrombotic therapy after acute stroke and TIA in patients with AF.

Download Full-text