ACUTE STROKE MANAGEMENT

Abstract

Acute care in stroke means early diagnostic assessment and immediate therapy. The current large number of therapies undergoing preclinical and clinical development for acute ischemic stroke suggest that several new drugs may be available soon for clinical use. However, because of the I complexity of focal ischemic brain injury development and evolution, it is highly likely that each drug alone will have only modest beneficial effects. The effective treatment of acute ischemic stroke remains an important goal of modem medicine and substantive advances are occurring. Recently, thrombolytic therapy with tissue-type plasminogen activator (t-PA) was approved for selected patients with acute ischemic stroke. Thrombolytic agents are all plasminogen activators, but differ for their different selectivity and half life. t-PA, compared to streptokinase and urokinase is characterized for a greater fibrin selectivity, therefore, it preferentially activate fibrin-bound plasminogen, that is part of thrombi or emboli. t-PA fibrin-selectivity allows its intravenous administration, while urokinase require the intra-arterial route to obtain therapeutical results at acceptable doses. Fibrin selectivity, however, has to be differentiated from thrombus-selectivity; it means that t-PA promotes dissolution of thrombi as well as of hemostatic plugs present in blood vessels. t-PA has a very short half-life (6-8 minutes) compared to other thrombolytic agents.