Fagan S C, Zarowitz B J, Robert S
Wayne State University, Detroit, MI 48202.
Ann Pharmacother. 1992 Jan;26(1):73-80. doi: 10.1177/106002809202600114.
The primary objective of this article is to introduce the reader to the use of thrombolytics in the acute treatment of ischemic stroke. Theory and experimental evidence to support this approach are emphasized in addition to potential adverse effects of thrombolysis.
A MEDLINE search was used to identify pertinent literature, including reviews.
Studies were selected for detailed review if they involved stroke patients and addressed possible toxicities of therapy. Any abstracts concerning ongoing clinical trials also were reviewed.
Data from animal investigations using tissue plasminogen activator for the acute treatment of several models of cerebral ischemia were used to support the importance of early treatment (within six hours of symptom onset). Also, studies performed in animal models of stroke revealed that thrombolysis could be accomplished safely in acute ischemic stroke. All human studies published to data are anecdotal case reports, but point to the safety of thrombolysis if administered early. Reviews of ongoing multicenter trials are taken from published abstracts and proceedings.
Thrombolysis holds promise as a hyperacute therapy for acute stroke; however, the risk of intracerebral hemorrhage remains. Crucial to the success of this and any other therapy for acute stroke is the ability to treat patients within hours of symptom onset. Also, the importance of concomitant medications such as heparin and aspirin has not yet been addressed.
Pharmacists need to be knowledgeable of new treatments of stroke and the risks associated with them. As patient educators, pharmacists can contribute to public awareness by promoting the early recognition of stroke symptoms. As pharmacotherapists, pharmacists need to understand the risks and the important monitoring parameters related to thrombolysis. The results of ongoing multicenter clinical trials are awaited before making a final judgment on the usefulness of thrombolysis in acute ischemic stroke.
本文的主要目的是向读者介绍溶栓药物在缺血性脑卒中急性治疗中的应用。除了溶栓的潜在不良反应外，还强调了支持这种治疗方法的理论和实验证据。
使用MEDLINE检索来识别相关文献，包括综述。
如果研究涉及中风患者并探讨了治疗的可能毒性，则选择这些研究进行详细综述。任何有关正在进行的临床试验的摘要也进行了综述。
使用组织纤溶酶原激活剂对几种脑缺血模型进行急性治疗的动物研究数据，以支持早期治疗（症状发作后6小时内）的重要性。此外，在中风动物模型中进行的研究表明，急性缺血性脑卒中可以安全地进行溶栓治疗。目前已发表的所有人体研究均为轶事病例报告，但表明早期使用溶栓治疗是安全的。正在进行的多中心试验的综述取自已发表的摘要和会议记录。
溶栓作为急性中风的超急性治疗方法具有前景；然而，脑出血的风险仍然存在。对于这种及任何其他急性中风治疗方法的成功而言，关键在于能够在症状发作后的数小时内对患者进行治疗。此外，尚未探讨肝素和阿司匹林等伴随药物的重要性。
药剂师需要了解中风的新治疗方法及其相关风险。作为患者教育者，药剂师可以通过促进对中风症状的早期识别来提高公众意识。作为药物治疗师，药剂师需要了解与溶栓相关的风险和重要监测参数。在对溶栓在急性缺血性脑卒中治疗中的有效性做出最终判断之前，有待正在进行的多中心临床试验的结果。
