According to a paper published in the September issue of Archives
of Neurology, anti-clotting therapy does not seem to increase
the risk of bleeding or other adverse outcomes in patients who need
therapy to reduce their blood pressure after suffering from stroke.
Acute ischemic stroke occurs when a blood clot blocks blood flow to the
brain. Patients with this condition also usually have hypertension
(high blood pressure). Generic viagra pills no prescription Author Sheryl Martin-Schild, M.D., Ph.D.
(formerly of the University of Texas
Health Sciences Center at Houston and currently at Tulane University
Health
Sciences Center, New Orleans) and colleagues write that, "As many as 10
percent of otherwise eligible patients do not receive tissue
plasminogen activator (tPA), the only proved therapy for acute ischemic
stroke, because of severely elevated blood pressure." Previous
guidelines, write the authors, "Recommended against giving tPA
to treat acute ischemic stroke when aggressive measures (such as
continuous infusion or more than two infusions of anti-hypertensive
agents) are required to maintain blood pressure lower than 185/110
millimeters of mercury."
To further analyze the relationship between antihypertensive treatments
and adverse events in stroke victims, the researchers studied the
medical records of 178 patients with acute ischemic stroke who received
intravenous tPA within three hours. Fifty of the patients needed a
second therapy to lower blood pressure before tPA treatment could
begin, including 24 (48%) who received the drug nicardipine
either alone or together with the drug labetalol.
"We observed several important differences between patients who
required blood pressure-lowering treatment and those who did not,"
write the researchers. "They had more severe strokes and their blood
glucose concentration was higher, predicting they would have a worse
outcome if all other factors were equal. As expected, they more
frequently had a history of hypertension."
The investigators then statistically controlled for factors such as
age, baseline stroke severity, and blood glucose levels. They still
found no differences in adverse events, poor outcomes, or stroke
severity score at discharge between patients who received
antihypertensive treatments and those who did not.
"Overall, the results of the present study provide the first
experimental support for the revised American Heart Association
guidelines allowing tPA therapy in patients requiring aggressive blood
pressure management and also provides support for the use of
nicardipine in patients with acute ischemic stroke who are eligible for
thrombolytic therapy," they conclude. "Aggressive control of severely
elevated blood pressure is feasible and should not automatically
exclude otherwise eligible patients with acute ischemic stroke from
receiving thrombolytic therapy."
Aggressive Blood Pressure-Lowering Treatment Before
Intravenous Tissue Plasminogen Activator Therapy in Acute Ischemic
Stroke
Sheryl Martin-Schild; Hen Hallevi; Karen C.
Albright; Aslam M. Khaja; Andrew D. Barreto; Nicole R. Gonzales; James
C. Grotta; Sean I. Savitz
Archives of Neurology
(2008). 65(9):1174-1178.
Click
Here to View Abstract
Written by: Peter M Crosta
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