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Combination therapy with hypothermia for treatment of cerebral ischemia.
- Source :
-
Journal of neurotrauma [J Neurotrauma] 2009 Mar; Vol. 26 (3), pp. 325-31. - Publication Year :
- 2009
-
Abstract
- Mild hypothermia is an established neuroprotectant in the laboratory, showing remarkable and consistent effects across multiple laboratories and models of brain injury. At the clinical level, mild hypothermia has shown benefits in patients who have suffered cardiac arrest and in some pediatric populations suffering hypoxic brain insults. However, a review of the literature has demonstrated that in order to appreciate the maximum benefits of hypothermia, brain cooling needs to begin soon after the insult, maintained for relatively long period periods of time, and, in the case of ischemic stroke, should be applied in conjunction with the re-establishment of cerebral perfusion. Translating this to the clinical arena can be challenging, especially rapid cooling and the re-establishment of perfusion. The addition of a second neuroprotectant could potentially (1) enhance overall protection, (2) prolong the temporal therapeutic window for hypothermia, or (3) provide protection where hypothermic treatment is only transient. Combination therapies resulting in recanalization following ischemic stroke would improve the likelihood of a good outcome, as the experimental literature suggests more consistent neuroprotection against ischemia with reperfusion, than ischemia without. Since recombinant tissue plasiminogen activator (rt-PA) is the only FDA approved treatment for acute ischemic stroke, and acts to recanalize occluded vessels, it is an obvious initial strategy to combine with hypothermia. However, the effects of thrombolytics are also temperature dependent, and the risk of hemorrhage is significant. The experimental data nevertheless seem to favor a combinatorial approach. Thus, in order to apply hypothermia to a broader range of patients, combination strategies should be further investigated.
- Subjects :
- Animals
Body Temperature physiology
Brain blood supply
Brain metabolism
Brain physiopathology
Brain Ischemia metabolism
Brain Ischemia physiopathology
Clinical Protocols standards
Fibrinolytic Agents pharmacology
Fibrinolytic Agents therapeutic use
Humans
Hypothermia, Induced standards
Hypothermia, Induced trends
Risk Assessment
Stroke metabolism
Stroke physiopathology
Thrombolytic Therapy standards
Thrombolytic Therapy trends
Tissue Plasminogen Activator pharmacology
Tissue Plasminogen Activator therapeutic use
Brain Ischemia therapy
Hypothermia, Induced methods
Stroke therapy
Thrombolytic Therapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1557-9042
- Volume :
- 26
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of neurotrauma
- Publication Type :
- Academic Journal
- Accession number :
- 19216635
- Full Text :
- https://doi.org/10.1089/neu.2008.0594