Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Abciximab decreases ischemic complications during angioplasty. Intracoronary urokinase lyses intracoronary thrombus. We studied the combination of both drugs. Twenty-six consecutive patients with acute coronary syndromes and intracoronary thrombus underwent intervention with abciximab and intracoronary urokinase. All received aspirin and IV heparin. The dose of abciximab was a weight-adjusted bolus and a 12-hr infusion. The dose of urokinase was 250,000 to 633,000 units. Hemorrhagic complications were classified according to the TIMI study group. Hemoglobin and platelet counts were measured before and 12 and 48 hr after the procedure. Procedural success was achieved in 24 patients. There were no deaths or repeat interventions. No patient had a major bleeding complication. Only two had minor complications. One patient needed blood transfusion. None had a stroke or thrombocytopenia. The use of abciximab and intracoronary urokinase in the presence of intracoronary thrombus is associated with encouraging efficacy and few complications. Cathet. Cardiovasc. Intervent. 49:113-116, 2000.
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PMID:Safety and efficacy of abciximab use in conjunction with intracoronary urokinase in patients requiring angioplasty. 1062 83

Intra-arterial thrombolytic therapy has replaced systemic intravenous infusion of thrombolytic agents as a treatment modality for arterial occlusion in the limbs. Several catheter-guided techniques and various infusion methods and schemes have been developed. At present there is no scientific proof of definite superiority of any agent in terms of efficacy or safety but clinical practice favours the use of urokinase or alteplase. Studies which compared thrombolysis to surgical intervention suggest that thrombolytic therapy is an appropriate initial management in patients with acute occlusion of a native leg artery or a bypass graft. Underlying causative lesions are treated in a second step by endovascular or open surgical techniques. Severe bleeding is the most feared complication: the risk of hemorrhagic stroke is 1-2%.
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PMID:Thrombolysis in arterial occlusion. 1069 98

Thrombolysis is increasingly being used in treating acute ischemic stroke but it is also accompanied with a serious complication of cerebral hemorrhage in a dose-dependent fashion. As a lower dose may result in decreased effectiveness, we tested the efficacy of combining a neuroprotective agent, topiramate (TPM), with lower doses of intra-arterial urokinase in an embolic stroke model. Focal ischemia was produced by introduction of an autogenous thrombus into the right middle cerebral artery. Urokinase was infused via the ipsilateral internal carotid artery and neuroprotective agent, TPM, was administrated intra-peritoneally 2 h following ischemic insult. The animals were assigned to five groups: (1) control group (n=6); (2) urokinase 5000 units/kg (n=8); (3) urokinase at 2500 units/kg (n=8); (4) topiramate at 20 mg/kg (n=8); (5) urokinase at 2500 units/kg and topiramate at 20 mg/kg (n=8). Neurobehavioral outcome and the degree of brain infarct volume were assessed at 24 h. Three animals in the group treated by high dose urokinase developed intracranial hemorrhage but none in other groups. Animals in all medication-groups showed significant improvement in neurobehavioral score. Post-ischemia treatment with urokinase or TPM alone significantly attenuated brain infarct volume (low-dose urokinase, 39.1+/-13.0%, p<0.05; high-dose, 18.4+/-8.5%, p<0.001; TPM, 20. 1+/-11.2%, p<0.001) when compared to the control (54.2+/-9.04%). Addition of TPM to low dose urokinase achieved better neuroprotection (8.2+/-6.0%) than any single-drug-treated groups. Our data suggests that combination of low dose urokinase with a neuroprotective agent may benefit ischemic stroke treatment by improving neurologic recovery, attenuating infarction size, and reducing the risk of cerebral hemorrhage.
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PMID:Enhanced neuroprotection and reduced hemorrhagic incidence in focal cerebral ischemia of rat by low dose combination therapy of urokinase and topiramate. 1069 54

Clinical trials in the 1990s of intravenous thrombolysis for ischaemic stroke have involved over 3000 patients. Alteplase given within 3 hours of onset significantly reduces the combined end-point of death and disability. Although alteplase appears safe when given up to 6 hours after onset, individual trials have failed to confirm efficacy beyond 3 hours. Meta-analysis indicates that intravenous alteplase given up to 6 hours after stroke onset significantly reduces death or dependence 3 months after stroke. Two trials of intra-arterial pro-urokinase confirm benefits of treatment up to 6 hours in highly selected patients with angiographically confirmed proximal middle cerebral occlusion. Streptokinase increased the risk of early death significantly in 3 trials, with no overall reduction in eventual death and disability. Patients over 80 years have been excluded from most trials of alteplase, and experience in this age group is minimal. Increased incidence and poorer functional outcome in the elderly mean that thrombolysis may have greater absolute benefit in this group than in the young, but there is also a higher prevalence of absolute or relative potential contraindications to treatment (ranging from increased use of anticoagulant drugs to higher prevalence of atrial fibrillation). Further trials are necessary to address age restrictions and other important issues in the use of alteplase. Thrombolysis is likely to remain feasible for a minority of stroke patients of all ages, and there is a need for other acute treatment options.
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PMID:Thrombolytic therapy for stroke: a review with particular reference to elderly patients. 1073 63

Neuroserpin, a recently identified inhibitor of tissue-type plasminogen activator (tPA), is primarily localized to neurons within the central nervous system, where it is thought to regulate tPA activity. In the present study neuroserpin expression and its potential therapeutic benefits were examined in a rat model of stroke. Neuroserpin expression increased in neurons surrounding the ischemic core (ischemic penumbra) within 6 hours of occlusion of the middle cerebral artery and remained elevated during the first week after the ischemic insult. Injection of neuroserpin directly into the brain immediately after infarct reduced stroke volume by 64% at 72 hours compared with control animals. In untreated animals both tPA and urokinase-type plasminogen activator (uPA) activity was significantly increased within the region of infarct by 6 hours after reperfusion. Activity of tPA then decreased to control levels by 72 hours, whereas uPA activity continued to rise and was dramatically increased by 72 hours. Both tPA and uPA activity were significantly reduced in neuroserpin-treated animals. Immunohistochemical staining of basement membrane laminin with a monoclonal antibody directed toward a cryptic epitope suggested that proteolysis of the basement membrane occurred as early as 10 minutes after reperfusion and that intracerebral administration of neuroserpin significantly reduced this proteolysis. Neuroserpin also decreased apoptotic cell counts in the ischemic penumbra by more than 50%. Thus, neuroserpin may be a naturally occurring neuroprotective proteinase inhibitor, whose therapeutic administration decreases stroke volume most likely by inhibiting proteinase activity and subsequent apoptosis associated with focal cerebral ischemia/reperfusion. (Blood. 2000;96:569-576)
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PMID:Neuroserpin reduces cerebral infarct volume and protects neurons from ischemia-induced apoptosis. 1088 20

Cerebral venous thrombosis (CVT) is a disease with multiple known etiologies that present with a remarkably wide spectrum of clinical signs and symptoms. We present a case of a 34-year-old man with a history of meningeal symptoms for 1 week after receiving a lumbar injection for lower back pain. He subsequently developed dense right hemiplegia and global aphasia. Head magnetic resonance imaging revealed superior sagittal sinus thrombosis. The patient was started on intravenous heparin but deteriorated neurologically. Urokinase infusion directly into the superior sagittal sinus was performed, with striking functional and neurologic improvement. Lupus anticoagulant was positive. We also present the case of a 24-year-old pregnant woman who developed an acute onset of meningeal symptoms and resultant left hemiparesis. Head magnetic resonance angiography revealed thrombosis of right transverse and sigmoid sinuses. Protein S deficiency was found. She was started on intravenous heparin, then enoxaparin, with improvement in symptoms. These cases demonstrate that CVT can be a cause of stroke in young patients with hypercoagability disorders, and a heightened awareness of CVT will promote optimal medical care and functional outcomes. Excellent functional recovery is likely with early recognition and treatment of the underlying etiology, as well as successful lysis of the clot.
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PMID:Cerebral venous thrombosis in young adults: 2 Case reports. 1134 48

Recent advances in the diagnosis and treatment of stroke have justified its management as a medical emergency. This article summarises the current recommendations for the initial management of major types of stroke with emphasis on acute therapy for ischaemic stroke. Recommendations are based on results of well-designed clinical trials. An acute stroke care team and an acute stroke unit should be established in all regional hospitals. Diagnosis of stroke must be accurate. General management aims for prevention and treatment of neurological and systemic complications, whereas specific management varies according to the stroke type and the underlying pathogenic mechanisms. For selected patients with ischaemic stroke, intravenous recombinant tissue plasminogen activator or a modified viper venom within 3 hours of onset, or intra-arterial pro-urokinase within 6 hours may improve functional outcomes. Neurosurgical treatment is indicated for some patients with ischaemic or haemorrhagic strokes. Prevention of recurrence and rehabilitation are the core components of subsequent management.
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PMID:Cerebrovascular disease--advances in management. 1140 77

The safety and efficacy of selective intraarterial administration of urokinase in five male patients, (age range 30 to 65 years, mean 41.2 years), with occlusive stroke involving the carotid territory and a normal cranial computed tomography scan was evaluated. The time elapsed before treatment ranged from one to 10 hours. Digital subtraction angiography disclosed distal internal carotid artery occlusion in one patient and occlusion of the middle cerebral artery or its branches in the others. The urokinase dose ranged from 120,000 to 500,000 units. In two patients who received thrombolytic treatment within three hours of the onset of symptoms, there was a 100% recanalisation associated with excellent neurological recovery. In the remaining three patients, recanalisation rate varied from 0 to 50% with partial recovery in two and no recovery in one patient. None had a haemorrhagic transformation of the infarct. Although no firm conclusions can be drawn because of the small number of patients studied, selective intraarterial urokinase therapy appears to be safe and useful in patients with carotid territory stroke if undertaken early. Only through a multicenter, randomized, controlled trial, enough number of patients can be recruited to verify these observations.
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PMID:Selective intra arterial thrombolysis in acute carotid territory stroke. 1144 35

The authors abstracted the records of 43 patients treated with intra-arterial urokinase for acute ischemic stroke to identify predictors of serious complications. Sixteen (37%) had such a complication. Higher urokinase dose (>1.5 x 10(6) U), higher mean arterial blood pressure before treatment (>130 mm Hg), basilar occlusive strokes, and severe strokes were most predictive of these complications. Although urokinase is no longer manufactured, these findings identify patients at risk for complications from other intra-arterial thrombolytics.
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PMID:Intra-arterial urokinase for acute ischemic stroke: factors associated with complications. 1157 43

The authors report the case of a 67 year old man with a previous history of aortobifemoral arterial graft who had unstable angina after carotid endarterectomy. Coronary angiography by the right brachial artery was complicated by a cerebrovascular accident with a reactive coma, convulsions and respiratory problems. Selective angiography of the right vertebral artery showed an image of occlusive thrombosis of the basilar artery. In view of the clinical state and angiographic appearances, the authors decided on immediate intra-arterial thrombolysis with Urokinase which dissolved the clot and reestablished flow in the basilar artery, the cerebellar and posterior cerebral arteries. The outcome was favourable with immediate and good recovery of consciousness and hospital discharge on the sixth day without neurological or radiological sequellae. Cerebrovascular accident is a rare and potentially serious complication of left heart catheterisation which requires immediate cerebral angiography to determine the mechanism and propose an appropriate therapeutic approach.
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PMID:[Intra-arterial thrombolysis of a basilar vascular accident during coronary angiography]. 1160 67


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