DURATION OF NEUROPROTECTIVE TREATMENT FOR ISCHEMIC STROKE

Background-The therapeutic time window for thrombolysis appears to be extremely shea, probably because of the hemorrhagic complications asso ciated with late reperfusion of ischemic brain tissue. Other neuroprot ective forms of treatment continue to be developed, although their eff icacy has yet to be conclusively proved in patients. The duration of t reatment in recent phase 3 trials ranges from a single bolus injection to 12 weeks of oral therapy. Summary of Review-In this article we dis cuss the factors that should influence the choice of route and duratio n of treatment. Excitotoxic injury following stroke evolves over at le ast 4 hours in rodents and possibly beyond 48 hours in humans. In addi tion, autoregulation and local cerebral perfusion are deranged for app roximately 72 hours in patients with stroke. Neuroprotection should pr ovide cover during this critical time. Conclusions-Important considera tions influencing drug administration should include the pharmacology of the compound (pharmacokinetics, mechanism of action, preclinical to xicity, and pharmaceutical properties), its safety and tolerability in patients, and the likelihood of continuing or recurrent cerebral isch emia, along with practical issues such as ease of administration and i nteractions with early rehabilitation and other therapies. Optimizatio n of treatment will be possible only when neuroprotection is confirmed to be effective.