Platelet GPIIb/IIIa Receptor Antagonists in Human Ischemic Brain Disease

Seitz, Rüdiger J.; Siebler, Mario

doi:10.2174/157016108783331303

Cited by 27 publications

(25 citation statements)

References 54 publications

(68 reference statements)

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“…The rationale for this combined treatment is to prevent a downstream re-occlusion subsequent to thrombolysis [10,11]. In fact, the present observations correspond closely to a recanalization of TIMI II or III in about 70% of patients subjected to combined thrombolysis with 20 mg rtPA followed by a continuous infusion of tirofiban [12]. It is beyond the scope of this study to explore whether additional mechanical approaches may be useful in proximal MCA occlusions to enhance rapid recanalization or in patients who do not respond to systemic thrombolysis.…”

Section: Discussionsupporting

confidence: 65%

“…Patients were subgrouped into a group with recanalization and lacking recanalization after 24 h following thrombolysis (table 1). Thrombolysis was performed with an intravenous bolus of 20 mg rtPA within 3 h after stroke onset followed immediately by an infusion of body weight-adjusted tirofiban (0.4 µg/kg body weight/min for 30 min followed by 0.1 µg/kg body weight/min) [12]. Patients were treated according to their neurological evaluation, the initial MRI, blood serum data including blood sugar and C-reactive protein, as well as continuous blood pressure monitoring.…”

Section: Methodsmentioning

confidence: 99%

“…The GPIIb/IIIa receptor antagonists selectively bind to the platelet integrin αIIbβIII fibrinogen receptor and thereby inhibit the adenosine diphosphate-induced platelet aggregation [10,11]. The combined use of a bolus of low-dose rtPA and tirofiban is not the treatment standard but was shown to be safe and allowed for a marked early recovery [12]. …”

Section: Introductionmentioning

confidence: 99%

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Failed Recovery from Thrombolysis Is Predicted by the Initial Diffusion Weighted Imaging Lesion

Seitz¹,

Oberstrass²,

Ringelstein

et al. 2011

Cerebrovasc Dis

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Background: The clinical response to systemic thrombolysis with recombinant tissue plasminogen activator (rtPA) is thought to depend on an early recanalization. We sought to investigate the effect of early recanalization on stroke lesion development as assessed with magnetic resonance imaging (MRI). Methods: Thirty-seven consecutive stroke patients (66 ± 13 years) treated with systemic thrombolysis with rtPA and tirofiban were grouped according to successful or failed recanalization as assessed on angiographic imaging. Infarct lesions were determined volumetrically in MRI prior to treatment and after 4 days. Results: Patients were severely affected (median National Institutes of Health Stroke Scale 14) and had significantly larger perfusion (PWI) than diffusion weighted imaging (DWI) lesion volumes. Ten patients with failed recanalization of the internal carotid or the middle cerebral artery did not improve. Their PWI and DWI lesion volumes were larger and the apparent diffusion coefficient more depressed than in the 27 patients with significant improvement and successful recanalization (p < 0.001). The DWI lesion volumes increased profoundly in the patients with failed recanalization (p < 0.001) but only little in the patients with successful recanalization. Multivariate regression analysis showed a relation of the initial DWI lesion volumes to the DWI lesion volumes at follow-up and the neurological recovery. Conclusions: The ischemic brain damage was particularly severe in patients with no recanalization already before systemic thrombolysis and predicted further lesion growth and failed recovery.

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Section: Discussionsupporting

confidence: 65%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Failed Recovery from Thrombolysis Is Predicted by the Initial Diffusion Weighted Imaging Lesion

Seitz¹,

Oberstrass²,

Ringelstein

et al. 2011

Cerebrovasc Dis

Self Cite

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“…645,646 A series of studies evaluated one of these agents, abciximab. These included case reports and small clinical series; in some cases, the agent was given as monotherapy and in others as an adjunct, usually with pharmacological fibrinolysis or mechanical thrombectomy.…”

Section: Intravenous Antiplatelet Agentsmentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,331

1,801

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Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

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“…The observation that the platelet aggregation and thrombus formation require the binding of fibrinogen to platelet through Glycoprotein (GP) IIb/IIIa receptor prompted a series of studies on intravenously administered platelet GPIIb/IIIa receptor antagonist (eptifibatide, abciximab, tirofiban) aimed at preventing plasminogen bridges between platelets, and disintegrating thrombi 41 . However, fibrinogen binding to this receptor is the last step in platelet aggregation; antagonists can inhibit this process whatever is the agonist.…”

Section: Antiplatelet Therapymentioning

confidence: 99%

Pharmacological Treatment of Acute Ischemic Stroke: A Review

Nayak¹,

Kumar²,

Sah³

2017

Int. Res. J. Pharm.

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Stroke is severe neurological disorder characterized by interruption of blood circulation into the brain and the leading cause of serious long-term disability. The central goal of therapy in ischemic stroke is to preserve tissue in the ischemic penumbra, where perfusion is decreased but sufficient to stave off infarction. Therefore, the fundamental treatment of AIS relies on prompt recanalisation and reperfusion of the threatened, but potentially salvageable, ischemic penumbra. Intravenous (iv) thrombolysis with recombinant tissue plasminogen activator (rtPA) remains the current strategy. However, other thrombolysis is underused, owing to various exclusion criteria that limit the number of treated patients. Other thrombolytics are under investigation. Intra-arterial thrombolysis and mechanical thrombectomy devices is also increasingly applied. This review analyses the current status and the problem of the pharmacological treatment of acute ischemic stroke.

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Platelet GPIIb/IIIa Receptor Antagonists in Human Ischemic Brain Disease

Cited by 27 publications

References 54 publications

Failed Recovery from Thrombolysis Is Predicted by the Initial Diffusion Weighted Imaging Lesion

Failed Recovery from Thrombolysis Is Predicted by the Initial Diffusion Weighted Imaging Lesion

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Pharmacological Treatment of Acute Ischemic Stroke: A Review

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