Fibrinolysis in acute CVA: the current status.

Abstract

The use of thrombolytic therapy in acute ischemic stroke is still today a somewhat controversial subject. We come across authors who defend its undisputed use in adequately selected cases, others who are more sceptical and habitually place a question mark on this subject and a third group in expectation. Intra-arterial thrombolysis has very precise indications, its use in vertebrobasilar ischemic stroke remains inconclusive, eventually with a wider window. Five important randomised studies have taken place in recent years with thrombolysis administered intravenously. All three studies with Estreptoquinase--MAST-E, MAST-I and ASK--ended prematurely due to the high rates of mortality and intracranial haemorrhage observed in the group of patients treated with this drug. From the two main studies with rt-PA-ECASS and NINDS, the American trial showed somewhat higher results. The Guidelines from the American Heart Association for the use of rt-PA in ischemic stroke are presented. Fibrinolysis, when successful, only permits the restoration of blood flow in the area of ischemic suffering. This implies that, simultaneously, other therapeutic measures will have to be implemented.