Book contents
- Frontmatter
- Contents
- Preface
- 1 The size of the problem of stroke
- 2 Understanding evidence
- 3 Organised acute stroke care
- 4 General supportive acute stroke care
- 5 Reperfusion of ischaemic brain by thrombolysis
- 6 Augmentation of cerebral blood flow: fibrinogen-depleting agents, haemodilution and pentoxifylline
- 7 Neuroprotection
- 8 Treatment of brain oedema
- 9 Anticoagulation
- 10 Antiplatelet therapy
- 11 Carotid artery revascularisation
- 12 Lowering blood pressure
- 13 Lowering blood cholesterol concentrations
- 14 Modification of other vascular risk factors and lifestyle
- 15 Antithrombotic therapy for preventing recurrent cardiogenic embolism
- 16 Arterial dissection and arteritis
- 17 Treatment of intracerebral haemorrhage
- 18 Treatment of subarachnoid haemorrhage
- References
- Index
6 - Augmentation of cerebral blood flow: fibrinogen-depleting agents, haemodilution and pentoxifylline
Published online by Cambridge University Press: 23 December 2009
- Frontmatter
- Contents
- Preface
- 1 The size of the problem of stroke
- 2 Understanding evidence
- 3 Organised acute stroke care
- 4 General supportive acute stroke care
- 5 Reperfusion of ischaemic brain by thrombolysis
- 6 Augmentation of cerebral blood flow: fibrinogen-depleting agents, haemodilution and pentoxifylline
- 7 Neuroprotection
- 8 Treatment of brain oedema
- 9 Anticoagulation
- 10 Antiplatelet therapy
- 11 Carotid artery revascularisation
- 12 Lowering blood pressure
- 13 Lowering blood cholesterol concentrations
- 14 Modification of other vascular risk factors and lifestyle
- 15 Antithrombotic therapy for preventing recurrent cardiogenic embolism
- 16 Arterial dissection and arteritis
- 17 Treatment of intracerebral haemorrhage
- 18 Treatment of subarachnoid haemorrhage
- References
- Index
Summary
Fibrinogen-depleting agents
Fibrinogen-depleting agents (defibrinogenating enzymes) reduce fibrinogen in blood plasma and therefore reduce blood viscosity and increase blood flow.
Evidence
Death
A systematic review of five randomised-controlled trials (RCTs) of fibrinogen-depleting agents (ancrod: four trials, defibrase: one trial) involving 2926 patients with acute ischaemic stroke revealed that random assignment to fibrinogen-depleting agents was associated with no statistically significant difference in death from all causes during the scheduled treatment period compared with control (relative risk (RR): 0.71, 95% confidence interval (CI): 0.44–1.13), or at the end of follow-up (RR: 0.98, 95% CI: 0.78–1.24) (Fig. 6.1) (Liu et al., 2003, 2004).
Symptomatic intracranial haemorrhage
Fibrinogen-depleting agents were associated with a non-significant excess of symptomatic intracranial haemorrhages at the end of the treatment period (RR: 2.64, 95% CI: 0.96–7.30, 2P=?0.06) (Fig. 6.2) (Liu et al., 2003).
Death or dependency
Random allocation to a fibrinogen-depleting agents was associated with a moderate reduction in the proportion of patients who were dead or dependent at the end of follow-up (RR: 0.90, 95% CI: 0.82–0.98, 2P=?0.02) (Fig. 6.3) (Liu et al., 2003).
Comments
Interpretation of the evidence
The Cochrane systematic review included the Stroke Treatment with Ancrod Trial (STAT) in which ancrod was given within 3 h of onset of ischaemic stroke and continued for 5 days (Sherman, et al., 2000, see p 432, 433), but it did not have access to unpublished data from ESTAT, a European trial testing ancrod treatment (European STAT) in a 6-h time window, which was terminated prematurely because it did not confirm the findings of the STAT trial in the USA.
- Type
- Chapter
- Information
- Stroke Treatment and PreventionAn Evidence-based Approach, pp. 120 - 125Publisher: Cambridge University PressPrint publication year: 2005