Medical Treatment of Cerebral Infarction / 대한뇌혈관외과학회지

Anticoagulants and antiplatelet agents have been widely used and studied in both the management of acute stroke and for stroke prevention. The use of anticoagulants and antiplatelet agents in acute ischemic stroke is aimed at preventing stroke recurrence and reducing stroke progression. Studies examining unfractionated heparin following acute ischemic stroke failed to show an overall benefit. Reductions in thromboembolic events and progression of stroke were offset by an increased risk of major bleeding including intracerebral hemorrhage. Low molecular weight heparin compounds and hepanoids in acute ischemic stroke similarly have failed to prove overall benefit when bleeding complications, especially intracerebral hemorrhage, are considered along with reductions in thromboembolic complications. Ancrod, an agent capable of reducing circulating fibrinogen levels has been shown in clinical trials to improve outcome following stroke when administered within three ours of stroke onset. Antiplatelet agents have been evaluated in acute ischemic stroke. The largest studies have examined the role of aspirin therapy (IST, CAST). Studies have shown a small but statistically significant improvement in the aspirin-treated patients treated within 48 hours. Abciximab, a IIB/IIIA inhibitor, has been studied in acute ischemic stroke with an acceptable safety profile and encouraging findings of potential benefit. These studies have led to an ongoing trial of Abciximab (ReoPro) in acute ischemic stroke. Other ongoing clinical trials in acute ischemic stroke include studies of clopidogrel following TIA and unfractionated heparin in acute ischemic stroke. Antithrombotic agents are widely used for stroke prevention. Long-term oral anticoagulation has been proven of benefit in the prevention of stroke in high risk patients with atrial fibrillation. Two large clinical trials in high risk patients with atrial fibrillation have examined a direct thrombin inhibitor, Ximelagatran, compared to warfarin for stroke prevention. These studies have shown similar thromboembolic events with Ximelagatran comparable to warfarin. The risks of bleeding were reduced with Ximelagatran as compared to warfarin treatment. Ximelagatran does not require regular monitoring of coagulation or dose adjustments. There is an increased risk of liver enzyme abnormalities in some patient receiving Ximelagatran. Antiplatelet agents are the mainstay of antithrombotic therapy for secondary stroke prevention with four agents currently approved for use (aspirin, ticlopidine, clopidogrel, and extended release dipyridamole plus aspirin). A number of studies are underway examining the role of antiplatelet agents in combination or for additional indications. These studies include MATCH, CHARISMA, SPS3, ARCH, CARESS, PROFESS, and WASID.

Current concepts in the management of acute ischemic stroke.

The treatment of stroke is multifaceted, and is governed by three, well established goals: 1) To minimize the extent of brain; 2) To medically support the stroke patient; and 3) To prevent further brain injury secondary to initial event or repeated vascular insults. Certain guidelines for emergency care, based on clinical experience and knowledge of pathophysiology, have been accepted in many institutions as the standard. This article provides guidelines about the current management of acute ischemic stroke based on currently available data from clinical trials. The target audiences for this article are emergency room physicians and neurologists, who manage the patients during the first few hours after stroke.

Clinical study on effect of Agkistrodon antithrombogenase in auxiliary treatment of rheumatoid arthritis / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the clinical effect of Agkistrodon antithrombogenase (AAT) in the treatment of rheumatoid arthritis (RA) and its possible mechanism.</p><p><b>METHODS</b>Besides the conventional non-steroid anti-inflammatory agents and disease-modifying anti-rheumatic drug, patients were treated supplementally with intravenous injection of AAT. The intracutaneous test showed allergic to AAT patients were treated with Salvia injection and taken as control group. Changes of related clinical indexes in the two groups were observed.</p><p><b>RESULTS</b>After 3 weeks treatment, condition of patients in both groups were improved clinically in joint swollen index, joint tenderness index, morning stiffness time, pain assessment (VAS) and health assessment questionnaire (HAQ) on daily life activity as well as ESR level (P < 0.05 or P < 0.01), with the VAS, HAQ and fibrinogen levels more significantly improved than those of control (P < 0.05 or P < 0.01), and the total effective rate higher in the AAT treated group than those in the control group (P < 0.05).</p><p><b>CONCLUSION</b>AAT has good effect on easing clinical symptoms of RA possibly through anti-inflammation and improving the microcirculation with less toxic and adverse reaction, so is worthy of recommendation.</p>

Importância da hemorreologia clínica no estudo do fluxo sanguíneo cerebral em condiçöes normais e na isquemia cerebrovascular / The importance of clinical hemorheology for the study of the cerebral blood flow in normal conditions and in cerebrovascular ischemia

É apresentada avaliaçäo crítica da importância da hemorreologia no estabelecimento da conduta terapêutica clínica na insuficiência cerebrovascular aguda. Com essa finalidade säo revistos aspectos relativos a fluxo sanguíneo cerebral, insuficiência cerebrovascular e hemorreologia clínica. Em funcçäo desses aspectos säo avaliados alguns dos principais medicamentos utilizados no presente no tratamento do acidente vascular cerebral e säo discutidas normas gerais para prevençäo e tratamento das isquemias cerebrais