Stroke Treatment With PAR-1 Agents to Decrease Hemorrhagic Transformation.
activated protein C
bleeding
hemorrhagic transformation
intracranial hemorrhage
ischemic stroke
stroke therapy
thrombectomy
tissue plasminogen activator
Journal
Frontiers in neurology
ISSN: 1664-2295
Titre abrégé: Front Neurol
Pays: Switzerland
ID NLM: 101546899
Informations de publication
Date de publication:
2021
2021
Historique:
received:
11
08
2020
accepted:
08
02
2021
entrez:
1
4
2021
pubmed:
2
4
2021
medline:
2
4
2021
Statut:
epublish
Résumé
Ischemic stroke is the most widespread cause of disability and a leading cause of death in developed countries. To date, the most potent approved treatment for acute stroke is recanalization therapy with thrombolytic drugs such as tissue plasminogen activator (rt-PA or tPA) or endovascular mechanical thrombectomy. Although tPA and thrombectomy are widely available in the United States, it is currently estimated that only 10-20% of stroke patients get tPA treatment, in part due to restrictive selection criteria. Recently, however, tPA and thrombectomy selection criteria have loosened, potentially allowing more patients to qualify. The relatively low rate of treatment may also reflect the perceived risk of brain hemorrhage following treatment with tPA. In translational research and a single patient study, protease activated receptor 1 (PAR-1) targeted therapies given along with thrombolysis and thrombectomy appear to reduce hemorrhagic transformation after recanalization. Such adjuncts may likely enhance the availability of recanalization and encourage more physicians to use the recently expanded selection criteria for applying recanalization therapies. This narrative review discusses stroke therapies, the role of hemorrhagic transformation in producing poor outcomes, and presents the data suggesting that PAR-1 acting agents show promise for decreasing hemorrhagic transformation and improving outcomes.
Identifiants
pubmed: 33790846
doi: 10.3389/fneur.2021.593582
pmc: PMC8005555
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
593582Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL142975
Pays : United States
Informations de copyright
Copyright © 2021 Lyden, Pryor, Minigh, Davis, Griffin, Levy and Zlokovic.
Déclaration de conflit d'intérêts
KP is employed by ZZ Biotech. JG, HL, JM, and BZ are paid consultants to ZZ Biotech. PL has received research funding from NIH to conduct trials of 3K3A-APC; received royalties from sales of the book Thrombolytic Therapy for Acute Ischemic Stroke, 3rd Edition; and received fees for occasional expert witness testimony. The Scripps Research Institute has intellectual property related to the topic of this review. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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