Hemorheological Effects of Pentoxifylline on Disturbed Flow Behavior of Blood in Patients with Cerebrovascular Insufficiency

E, Ott; Lechner, H; Fazekas, Franz

doi:10.1159/000115658

Cited by 36 publications

(18 citation statements)

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“…The decrease in plasma fibrinogen by ticlopidine [16] is paralleled by changes in leukocyte counts. In keeping with an inhibitory effect on plasma fibrinogen [17][18][19][20][21][22], pentoxifylline, a phosphodiesterase inhibitor, is known to increase intracellular levels of cAMP. Protein kinase C is involved in the regulation of plasma fibrinogen [7].…”

Section: Factors Affecting Plasma Fibrinogen Levelsmentioning

confidence: 99%

Drugs affecting plasma fibrinogen levels

Minno¹,

Mancini²

1992

Cardiovasc Drug Ther

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Current knowledge indicates that high plasma levels of fibrinogen help predict stroke and myocardial infarction. It is known that plasma fibrinogen is synthesized in the liver, that interleukin-6 (IL-6) affects this synthesis, and that, when exposed to appropriate stimuli, monocytes generate a variety of monokines, including IL-6. It is also known that prolonged administration of N-3 fatty acids, ticlopidine, fibrates, pentoxifylline, or alcohol lower plasma fibrinogen levels. The mechanism(s) involved in this effect are poorly understood. However, in view of the role of IL-6 and monocytes in the regulation of plasma fibrinogen levels, it is conceivable that the lowering effect of these drugs involves effects on some steps of the regulatory machinery. In addition to fibrinogen, IL-6 regulates the synthesis of other acute-phase proteins. This raises the question of whether high plasma fibrinogen levels do reflect the response of an acute-phase reactant to the severity of the atherosclerotic vascular damage taking place. Current evidence is inconclusive with respect to this possibility. On the other hand, the epidemiological data available indicate that measurements of plasma fibrinogen should be included in the cardiovascular risk-factor profile. In view of this, we believe that information emerging from population-based studies in which plasma fibrinogen is measured is important to identify appropriate directions to be followed to address unsolved issues in the area.

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Section: Factors Affecting Plasma Fibrinogen Levelsmentioning

confidence: 99%

Drugs affecting plasma fibrinogen levels

Minno¹,

Mancini²

1992

Cardiovasc Drug Ther

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“…Other therapeutic approaches seek to limit cerebral infarction by slowing cerebral metabolism, 1 controlling perifocal brain edema, 2 or enhancing collateral blood flow to the peri-infarct region. This is attempted by treatment with vasodilatation, 3 drugs that influence erythrocyte deformability, 4 or hemodilution. Hematocrit is the main determinant of whole-blood viscosity.…”

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confidence: 99%

Adjusted hypervolemic hemodilution in acute ischemic stroke.

Koller

Haenny

Hess

et al. 1990

Stroke

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We prospectively randomized 47 patients with acute ischemic stroke of the middle cerebral artery of <24 hours' duration to either adjusted hypervolemic hemodilution or control treatment and followed them up for 90 days. Rapid hemodilution to a target hematocrit of 30-35% as monitored with bedside determinations was achieved by using infusions of dextran 40, venesections, and infusions of additional crystalloid solution when necessary. There was no difference in the death rate between the two treatment groups. Of these 47 patients, 37 (19 in the hemodilution group and 18 in the control group) could be followed up for the entire study period of 3 months. The relative improvement in neurologic function from day 1 to days 8, 21, and 90 was significantly better in the hemodilution group than in the control group. In accordance, special tests for fine motor control of the paretic arm disclosed better performance in the hemodilution group. The frequency of patients with severe disability was significantly lower in the hemodilution group on days 8 and 21. Plasma viscosity (measured in 11 patients) was not affected by infusions of dextran 40. Vigorous hypervolemic hemodilution in patients with acute ischemic stroke is well tolerated and improves early neurologic outcome with an effect lasting at least 3 months. (Stroke 1990;21:1429-1434)

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“…26 Several clinical studies have suggested a potential therapeutic or prophylactic efficacy of PTX in ischemic cerebrovascular disorders. 27 " 32 Our study was designed to assess the efficacy and safety of PTX on the survival, neurologic deficits, and extent of recovery after acute nonhemorrhagic stroke using a randomized, placebocontrolled, double-blind protocol.…”

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confidence: 99%

Pentoxifylline in acute nonhemorrhagic stroke. A randomized, placebo-controlled double-blind trial.

Hsu

Norris

Hogan

et al. 1988

Stroke

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The efficacy and safety of pentoxifylline were assessed in 297 adult patients with ischemic stroke in a molticenter, doable-blind, randomized and placebo-controlled trial. Treatment was started within 12 hoars after the stroke onset Study medication was administered intravenously continuously (16 mg/kg/day, maximum 1,200 mg/day) for 3 days and per os (400 mg ti.d.) for the remainder of 28 days. Demographic data were comparable, and functional impairment and mortality (pentoxifylline 12%, placebo 10%) were not different between the two groups. Neurologic deficit scores Improved from baseline admission scores during the 4-week study in both groups but did not differ between groups at admission or throughout the study except during the first few days when the consciousness level (Days 1 and 2), motor function (Days 1 and 2), cranial nerve function (Days 1-4), and total neurologic deficit scores (Days 1 and 2) were better in the pentoxifylline group than in the placebo group, especially in a subset of patients with severe deficits at admission. Laboratory values and side effects were also comparable between groups. Our study indicates that pentoxifylline can be given safely in patients with acute ischemic stroke. Although pharmacologk effects were present during the first few days, the clinical benefits were small and not sustained.

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Hemorheological Effects of Pentoxifylline on Disturbed Flow Behavior of Blood in Patients with Cerebrovascular Insufficiency

Cited by 36 publications

References 0 publications

Drugs affecting plasma fibrinogen levels

Drugs affecting plasma fibrinogen levels

Adjusted hypervolemic hemodilution in acute ischemic stroke.

Pentoxifylline in acute nonhemorrhagic stroke. A randomized, placebo-controlled double-blind trial.

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