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  STROKE


 Editor: Asher Kimchi, MD
 

Blocking Early Steps in Platelet Aggregation Reduces Stroke Infarct Size Without Increasing Intracerebral Hemorrhage (ICH)
Ischemic stroke is the third leading cause of death and permanent disability in industrialized countries. Currently, the anticoagulant therapies available to treat ischemic stroke offer moderate benefit on stroke progression and recurrence, but this is outweighed by a significant increase in the rate of ICH. During ischemia, platelets can adhere to hypoxic endothelial cells by binding of their glycoprotein (GP) Ib receptor to von Willebrand factor (vWF) on the endothelial surface. Additionally, subendothelial matrix proteins are exposed, allowing firm attachment of platelets to the vessel by binding of collagens to their GPVI receptor. These processes lead to activation of platelet GPIIb/IIIa and platelet aggregation. Christoph Kleinschnitz, MD et al from the University of Würzburg in Würzburg, Germany tested the hypothesis that blocking platelet aggregation and activation at various steps in these pathways may reduce infarct size following ischemic stroke. Their results, published in the May 1, 2007 issue of Circulation, showed that targeting platelet GPIb or GPVI receptors protects mice from ischemic brain injury in an experimental stroke model without increasing bleeding complications. In contrast, blockade of the final common pathway of platelet aggregation with anti-GPIIb/IIIa antibodies had no positive effect on stroke outcome and dose-dependently raised the incidence of ICH and mortality. MORE»

High-Dose Atorvastatin Reduces the Overall Incidence of Stroke or Transient Ischemic Attack
It has become evident that patients who take statins have a decreased incidence of stroke and cardiovascular risks. It has been, however, unknown whether patients with previous strokes or transient ischemic attacks (TIA) would benefit from taking statins. A study led by The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators showed that in patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events. This study was published in the August 10, 2006 issue of The New England Journal of Medicine. MORE»

Blood Pressure Lowering Regimen Delays the Progression of White Matter Hyperintensities in Patients With Stroke -
White matter hyperintensities (WMHs) are observed on brain MRI’s in elderly people and people with stroke. They are areas of demyelination and infarct that manifest in clinical outcomes such as dementia, depression and gait disturbances. High blood pressure is known to be a risk factor for WMH and they are said to increase over time. Carole Dufouil, PhD et al from the INSERM in France studied whether lowering blood pressure would reduce the incidence of WHMs. This study, published in the September 13, 2005 issue of Circulation journal found that an active blood pressure-lowering regimen stopped or delayed the progression of WHMs in patients with cerebrovascular disease.  MORE...

In Large, Primary-Prevention Trial Among Women, Aspirin Lowered the Risk of Stroke Without Affecting the Risk of Myocardial Infarction

Use of Ultrasound Safely Enhances t-PA Thrombolysis for Acute Ischemic Stroke 

 

 

 

 


 

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