Reperfusion therapy for stroke

Stroke is a heterogenous disease, but about 85% of strokes are as a result of cerebral ischaemia due to arterial occlusion. It seems logical to assume that, as in myocardial infarction, treatment designed to dissolve clots sh ould be helpful. We now have a substantial amount of data on the use of aspirin, heparin and thrombolytic drugs in the treatment of acute ischaemic stroke. Aspirin 300 mg daily has a modest effect in reducing mortality and handicap when used within 48 hours of stroke onset. The beneficial effects of low dose, medium dose subcutaneous unfractionated heparin, and various low molecular weight heparins in reducing early recurrent ischaemic stroke seem to be outweighe d by haemorrhagic side effects. Streptokinase used within six hours of stro ke onset results in excess mortality with some reduction in handicap in sur vivors, while in carefully selected patients recombinant tissue plasminogen activator (r-TPA) may be less hazardous. At the moment it is unclear which stroke patients will benefit from the use of r-TPA, and the use of criteri a, as outlined by the NINDS group, means that only a very small proportion of stoke victims are suitable for thrombolytic therapy. Further research is necessary, while the concept of a 'Brain Attack' with a ppropriate urgency being used in the assessment of possible stoke needs dev elopment.