Pentoxifylline, propentofylline and pentifylline for acute ischaemic stroke

Bath, Philip M; Bath‐Hextall, Fiona

doi:10.1002/14651858.cd000162.pub2

Cited by 33 publications

(7 citation statements)

References 23 publications

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“…Among the drugs affecting the rheological properties of blood, only pentoxifilline should improve the elasticity of red cells but there have also been reports denying such effect [14] or even any role of this drug in the secondary prevention of cerebral ischaemia [15]. On the other hand, the protective mechanisms of feedback may turn out to be very important [16].…”

Section: Discussionmentioning

confidence: 99%

Hemorheological changes dependent on the time from the onset of ischemic stroke

Kowal¹,

Marcinkowska‐Gapińska²

2007

Journal of the Neurological Sciences

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Section: Discussionmentioning

confidence: 99%

Hemorheological changes dependent on the time from the onset of ischemic stroke

Kowal¹,

Marcinkowska‐Gapińska²

2007

Journal of the Neurological Sciences

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“…A meta-analysis of these studies calculated a hazard rate of 0.65 (95% CI 0.41 to 1.04) for those receiving pentoxifylline. 49 Hence, there was a strong trend ( just barely missing statistical significance) suggesting that poststroke pentoxifylline could reduce early mortality by about one-third.…”

Section: Prevention Of Stroke and Transient Ischaemic Attacksmentioning

confidence: 99%

Pentoxifylline for vascular health: a brief review of the literature

2016

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Pentoxifylline is a methylxanthine derivative that has been used for several decades in the symptomatic management of intermittent claudication. For reasons that remain fairly obscure, this drug benefits blood rheology in a number of complementary ways: decreasing blood and plasma viscosity, lowering plasma fibrinogen while promoting fibrinolysis, and improving blood filterability by enhancing erythrocyte distensibility and lessening neutrophil activation. Anti-inflammatory effects on neutrophils and macrophage/monocytes—some of them attributable to pentoxifylline metabolites—appear to play a mediating role in this regard. Although clinical trials with pentoxifylline have often been too small in size to reach statistically significant findings regarding impacts on hard end points, a review of the existing literature suggests that pentoxifylline may have potential for slowing the progression of atherosclerosis, stabilising plaque, reducing risk for vascular events, improving the outcome of vascular events, dampening the systemic inflammatory response following cardiopulmonary bypass, providing symptomatic benefit in angina and intermittent claudication, enhancing cerebral blood flow in patients with cerebrovascular disease while slowing progression of vascular dementia, improving prognosis in congestive heart failure, and aiding diabetes control. This safe and usually well-tolerated drug works in ways quite distinct from other drugs more commonly used for cardiovascular protection, and hence may confer complementary benefit when used in conjunction with them. Major clinical trials of adequate statistical power are now needed to confirm the scope of benefits that pentoxifylline can confer; studies evaluating hard end points in acute coronary syndrome, stroke/transient ischaemic attack and systolic heart failure might be particularly valuable.

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“…In the first systematic review and meta-analysis that included two RCTs ( n = 119) of aminophylline in patients with ischemic stroke, there was no difference in early death and deterioration or death or disability at the end of the follow-up ( 54 ). A systematic review and meta-analysis of pentoxifylline and propentofylline, also in ischemic stroke, included five trials ( n = 793) ( 55 ). No study on pentifylline was included.…”

Section: Resultsmentioning

confidence: 99%

A systematic-search-and-review of registered pharmacological therapies investigated to improve neuro-recovery after a stroke

Lee,

Uchiyama,

Kusuma

et al. 2024

Front. Neurol.

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BackgroundStroke burden is largely due to long-term impairments requiring prolonged care with loss of productivity. We aimed to identify and assess studies of different registered pharmacological therapies as treatments to improve post-stroke impairments and/or disabilities.MethodsWe performed a systematic-search-and-review of treatments that have been investigated as recovery-enhancing or recovery-promoting therapies in adult patients with stroke. The treatment must have received registration or market authorization in any country regardless of primary indication. Outcomes included in the review were neurological impairments and functional/disability assessments. “The best available studies” based on study design, study size, and/or date of publication were selected and graded for level of evidence (LOE) by consensus.ResultsOur systematic search yielded 7,801 citations, and we reviewed 665 full-text papers. Fifty-eight publications were selected as “the best studies” across 25 pharmacological classes: 31 on ischemic stroke, 21 on ischemic or hemorrhagic stroke, 4 on intracerebral hemorrhage, and 2 on subarachnoid hemorrhage (SAH). Twenty-six were systematic reviews/meta-analyses, 29 were randomized clinical trials (RCTs), and three were cohort studies. Only nimodipine for SAH had LOE A of benefit (systematic review and network meta-analysis). Many studies, some of which showed treatment effects, were assessed as LOE C-LD, mainly due to small sample sizes or poor quality. Seven interventions had LOE B-R (systematic review/meta-analysis or RCT) of treatment effects.ConclusionOnly one commercially available treatment has LOE A for routine use in stroke. Further studies of putative neuroprotective drugs as adjunctive treatment to revascularization procedures and more confirmatory trials on recovery-promoting therapies will enhance the certainty of their benefit. The decision on their use must be guided by the clinical profile, neurological impairments, and target outcomes based on the available evidence.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=376973, PROSPERO, CRD42022376973.

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Pentoxifylline, propentofylline and pentifylline for acute ischaemic stroke

Cited by 33 publications

References 23 publications

Hemorheological changes dependent on the time from the onset of ischemic stroke

Hemorheological changes dependent on the time from the onset of ischemic stroke

Pentoxifylline for vascular health: a brief review of the literature

A systematic-search-and-review of registered pharmacological therapies investigated to improve neuro-recovery after a stroke

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