Current Treatment

6.10.5.1 Stroke

The only pharmacological agent available for the treatment of acute ischemic stroke in Western countries, including the USA, are the thrombolytic agents, which are used to dissolve acute thromboembolic blood clots. The first of these approved was recombinant tissue plasminogen activator (rTPA). Although hailed as a breakthrough for stroke treatment when first approved, its use is severely limited, since it is only approved for use during the first 3 h after stroke onset. Its use beyond that therapeutic window can lead to secondary hemorrhagic stroke. Thus, only the handful of stroke patients who present for emergency treatment within the first 3 h can be treated. This relatively short window of opportunity is further complicated by the fact that all patients first undergo a computed tomography (CT) scan to rule out the possibility of the patient having suffered a hemorrhagic, rather than a thromboembolic, stroke. There is some indication that newer thrombolytic agents may have less risk than rTPA in terms of possible hemorrhagic conversion.36 There are also experimental data which show that the combined use of a neuroprotective agent along with the thrombolytic agent may reduce the risk of secondary hemorrhage and thus extend the therapeutic window for safe thrombolysis. However, no neuroprotective agents are currently approved in the USA.

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