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  • Writer's pictureOren Zarif

Neuroprotective Agents Are a Promising Treatment Option in Stroke Patients - Oren Zarif - TPA Stroke


Neuroprotective agents are a promising new treatment option in tPA-treated stroke patients. Although neuroprotectants are often considered toxic, they may actually extend the therapeutic window and improve functional outcomes. There are several agents that interfere with the ischemic cascade and BBB destabilization. Moreover, they may protect dying neurons. These agents may also reduce the incidence of HT and ICH. However, there are still few promising trials in this area.

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Several subgroups of tPA-treated stroke patients have been identified. Although most of these groups have high tPA toxicity rates, tPA-treated patients may be at increased risk of bleeding. This is why the American Academy of Neurology and the American College of Emergency Physicians formed a joint development panel to study the risks and benefits of this therapy in the treatment of stroke patients. These subgroups may require a different approach in clinical practice.

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Recent studies have suggested that administering tPA during a head CT scan will reduce the time a patient spends in a recovery room. This would also improve health outcomes for other patients. But while reducing OTT time is a desirable outcome, it should not be at the cost of quality of care for other patients. The tPA stroke trial team is now actively training other hospitals on the use of this treatment. These findings highlight the need for further studies.

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In addition to NINDS study findings, more than a dozen clinical trials have been conducted involving tPA for acute ischemic stroke. This project has changed the practice for tPA in AIS. In open-label routine clinical use, tPA has improved health outcomes without increasing mortality rates. These are encouraging results, but more studies are needed to confirm the clinical benefit of this drug. Aside from the safety of this treatment, there is a lack of effective alternative to tPA.

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The tPA stroke trial has found that tPA significantly improved early clinical outcomes, with more patients achieving no or minimal disability than in the placebo group. The study also found that tPA is more effective for patients who have severe stroke symptoms than those who are not. The tPA group had a relative risk of 1.2 and 0.9 to 1.5 times as high as the placebo group. In addition, four assessments scales were used to determine whether patients had a favorable outcome at 3 months.

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The NINDS study site included Emergency Medicine leaders who led the first study of combined IV and IA tPA. These leaders were quick to level false attacks against Genentech and re-analyzed the data to support their arguments. To make matters worse, some even hired an investigative reporter to write a damaging article about the study and published it in the BMJ. A new study is needed to determine whether the FDA approval of tPA was justified.

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The tPA stroke study also showed that tPA significantly reduced the risk of ischemic vascular complications, including hemorrhage and death. However, there were several disadvantages of tPA. In addition to causing more damage to the brain, tPA activates matrix metalloproteases, which further disrupt the BBB. In addition to tPA stroke, there are several studies on tPA and acute ischemic stroke.

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Argatroban is an agent that inhibits vascular thrombosis and may therefore serve as a tPA helper. Argatroban was successfully administered to ten patients undergoing EVT. The drugs did not delay the study's outcome measures. In fact, nine patients had good reperfusion, and none of the 10 patients developed symptomatic ICH or EVT complications. So, tPA may be an effective treatment option in ischemic/reperfusion stroke.

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Moreover, the combination of tPA and a purine molecule, called epigallocatechin gallate (EGCG), has anti-inflammatory and neuroprotective effects. In a transient MCAO mouse model, tPA + EGCG significantly reduced the infart volume and the edema. Furthermore, the combination of tPA and EGCG reduced BBB breakage, reducing the volume of the infart.

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Although the plaintiffs were able to prove that tPA was ineffective in a patient with AIS, the court found that tPA was not a good treatment option for their patients. The patient's decision should be documented so that it will be easier to prove negligence and malpractice in a lawsuit. Although a hospital is not immune to tPA-related claims, it should invest in human resources in order to facilitate thrombolytic therapy.

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