Therapeutic Potential of Platelet Glycoprotein IIb/IIIa Receptor Antagonists in Acute Ischaemic Stroke
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Acute ischaemic stroke is the result of an abrupt interruption of focal cerebral blood flow. In the majority of cases, this interruption is caused by an acute thromboembolism. Based on clinical experience in the treatment of acute coronary syndromes, platelet glycoprotein (GP) IIb/IIIa receptor antagonists alone, in combination with reduced doses of thrombolytic agents, or as complementary therapy for short-term mechanical interventions merit consideration as a class of agents with potential use in ischaemic stroke. Research to date and extrapolation from the cardiac literature suggest significant, but as yet unproven, potential for the use of GP IIb/IIIa receptor antagonists in the treatment of acute ischaemic stroke. This potential exists both at the site of the thromboembolic occlusion and at the distal microvascular level. This article reviews the scientific rationale and available evidence for the potential use of platelet GP IIb/IIIa receptor antagonists in acute ischaemic stroke.
KeywordsMiddle Cerebral Artery Occlusion Acute Ischaemic Stroke Abciximab Alteplase Carotid Artery Stenting
Dr Pancioli is the principal investigator and Dr Brott is the principal neurologist for the CLEAR (Combined approach to Lysis using Eptifibatide and rt-PA in acute ischemic stroke) trial. The trial is funded by the National Institute of Neurological Disorders and Stroke (1 P50 NS44283-01). The trial medications are provided by the manufacturers at no cost: eptifibatide provided by Millenium Pharmaceuticals Inc., Cambridge (MA), USA; rt-PA provided by Genentech Inc., San Francisco (CA), USA.
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