PENTOXIFYLLINE IN ACUTE ISCHEMIC STROKE PATIENTS WITH BLOOD HYPERVISCOSITY
DOI:
https://doi.org/10.22159/ijap.2018.v10s1.68Keywords:
Blood hyperviscosity, Digital microcapillary, Ischemic stroke, PentoxifyllineAbstract
Objective: This study evaluated the efficacy of pentoxifylline, a hemorrheologic agent, for treating acute ischemic stroke in patients with blood
hyperviscosity.
Methods: Patients were randomly allocated within 3 days of stroke onset to study or control treatment. All the patients received the standard acute
ischemic stroke treatment. The study treatment was intravenous pentoxifylline 1200 mg/day for 5 consecutive days and oral pentoxifylline 800 mg
in two divided doses for 23 days. Blood viscosity was evaluated on days 7 and 30. The outcomes were assessed by the National Institutes of Health
Stroke Scale (NIHSS), modified Rankin Scale, and Barthel index (BI) criteria.
Results: The median baseline viscosity was 6.89 poise in the study and 6.46 poise in the control groups and had decreased in all the patients on
days 7 and 30. The decrease in the study group on day 7 (1.13 poise) was greater than that in the control group (0.57 poise); the difference was not
significant. The NIHSS score improved by 32% in the study group (relative risk [RR]=1.00, 95% confidence interval [CI]: 0.421–3.556; p=1.00). At
1-month, 67% of the study group had a good functional outcome (RR=1.026, 95% CI: 0.656–1.605; p=0.909).
Conclusion: Pentoxifylline decreased blood viscosity and improved clinical outcome in this patient series.
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References
Ministry of Health. Basic Health Research. Agency of Health Research
and Development the Republic of Indonesia. Jakarta: Ministry of
Health Republic of Indonesia; 2013.
Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM,
et al. Change in stroke incidence, mortality, case-fatality, severity, and
risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford vascular
study). Lancet 2004;363:1925-33.
Fadhli H, Meisadona G, Kurniawan M, Mesiano T. Stroke Patient
Mortality in Cipto Mangunkusumo Hospital in 2014. Jakarta: Presented
at the Jakarta Neurology Workshop Exhibition and Symposium
(JAKNEWS); 2015.
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A,
et al. An updated definition of stroke for the 21st century: A statement
for healthcare professionals from the American heart association/
American stroke association. Stroke 2013;44:2064-89.
Caplan LR, editor. Basic pathology, anatomy, and pathophysiology
of stroke. Caplan’s Stroke: A Clinical Approach. Philadelphia, PA:
Saunders Elsevier; 2009.
Ott E, Fazekas F, Tschinkel M, Bertha G, Lechner H. Rheological
aspects of cerebrovascular disease. Eur Neurol 1983;22 Suppl 1:35-7.
Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity
and risk of cardiovascular events: The Edinburgh artery study. Br J
Haematol 1997;96:168-73.
Thomas DJ. Whole blood viscosity and cerebral blood flow. Stroke
;14:1012-3.
Rasyid A, Misbach J, Purba JS, Timan IS, Sukrisman L, Mansyur M,
et al. The role of a novel digital microcapillary instrument in detecting
blood and plasma hyperviscosity. Acta Med Indones 2014;46:226-32.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC,
Becker K, et al. 2018 guidelines for the early management of patients
with acute ischemic stroke: A guideline for healthcare professionals
from the American heart association/American stroke association.
Stroke 2018;49:e46-e110.
Ward A, Clissold SP. Pentoxifylline. A review of its pharmacodynamic
and pharmacokinetic properties, and its therapeutic efficacy. Drugs
;34:50-97.
Bowton DL, Stump DA, Prough DS, Toole JF, Lefkowitz DS, Coker L,
et al. Pentoxifylline increases cerebral blood flow in patients with
cerebrovascular disease. Stroke 1989;20:1662-6.
Vakili A, Mojarrad S, Akhavan MM, Rashidy-Pour A. Pentoxifylline
attenuates TNF-α protein levels and brain edema following temporary
focal cerebral ischemia in rats. Brain Res 2011;1377:119-25.
Rasyid A. The Effectiveness of Digital Microcapillers as a Measure
of the Value of Blood Viscosity to Predict the Prognosis of Acute
Ischemic Stroke. Dissertation. Jakarta: Faculty of Medicine Universitas
Indonesia; 2014.
Kuriakose C, Naseem SM, Tharakan NS, Sattanathan K, Sambath KR.
A prospective study of clinical profile of stroke in a tertiary care
hospital. Asian J Pharm Clin Res 2016;9:178-81.
Ahmed HH, Shousha WG, Mezayen HA, Emara IA, Hassan ME.
Clinical significance of procalcitonin and c-reactive protein in the
prediction of cardiovascular complications in patients with Type 2
diabetes mellitus. Asian J Pharm Clin Res 2017;10:297-306.
Kristiyowati AD, Andrajati R, Bahtiar A. Comparison of clopidogrel and
acetosal in the prevention of reccurent ischemic stroke at Dr. Moewardi
regional general hospital. Asian J Pharm Clin Res 2017;10:145-50.
Coull BM, Beamer N, de Garmo P, Sexton G, Nordt F, Knox R, et al.
Chronic blood hyperviscosity in subjects with acute stroke, transient
ischemic attack, and risk factors for stroke. Stroke 1991;22:162-8.
Whiteley W, Jackson C, Lewis S, Lowe G, Rumley A, Sandercock P,
et al. Inflammatory markers and poor outcome after stroke:
A prospective cohort study and systematic review of interleukin-6.
PLoS Med 2009;6:e1000145.
Hsu CY, Norris JW, Hogan EL, Bladin P, Dinsdale HB, Yatsu FM, et al.
Pentoxifylline in acute nonhemorrhagic stroke. A randomized, placebocontrolled
double-blind trial. Stroke 1988;19:716-22.
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