Medical treatment strategies. Intravenous thrombolysis, neuronal protection, and anti-reperfusion injury agents

Intravenous tPA was the first therapy to show improved recovery in stroke patients and is now approved for use. An associated risk of ICH, however, requires that patient selection for treatment with tPA be carefully made. Other intravenously and intra-arterially administered thrombolytic agents are currently being investigated for use in stroke; trials involving the thrombolytic streptokinase have been aborted because of high rates of ICH. Stroke treatments categorized as neuroprotective or anti-reperfusion injury agents are also being evaluated in clinical trials, although none have yet been found to be effective. Some, such as the NMDA receptor antagonists and the antileukocyte adhesion agents, have been limited by side effects and adverse drug reactions. Others, including citicoline, clomethiazole, and nalmefene, may have more efficacy in certain patient subgroups. Finally, a number of drugs in early studies offer new hope for reducing the devastating impact of stroke on society.