Randomized Clinical Stroke Trials in 2009

Problem statement: Stroke ranks as the leading cause of serious, long-term disability and death world-wide. It is estimated direct and indirect cost of stroke for 2009 was $68.9 billion. Approach: The objective of this review was to examine the effectiveness of emerging pharmacotherapy’s in patients with acute (≤2 weeks), sub-acute (2-12 weeks) and chronic (≥12 weeks) stroke studied in Randomized Control Trials (RCT’s) published in 2009. Medline search was performed to identify all RCT’s in acute, sub-acute and chronic stroke treatment in the year 2008. The search strategy used for Pub Med included key words such as Randomized Controlled Trials (RCT), Stroke OR cerebrovascular disorders OR CVA, Ischemic stroke OR ischemia, Hemorrhage OR intraparenchymal hemorrhage OR subarachnoid hemorrhage, Thrombolytics OR tissue plasminogen activator OR alteplase OR t-PA, Diabetes mellitus OR hyperglycemia, Hypertension OR raised blood pressure, Aspirin OR anti-platelets, Warfare OR anticoagulant, Antidepressants , Neuroprotectants and Coiling OR stents OR endovascular. Search limits included Human, Adult (age>19 years), English language and Publication date: 1/1/2009-12/31/2009. Results: Eleven categories of 27 RCT’s were found and analyzed. Conclusion: There was sufficient evidence to suggest that: (1) extending the time-window for administration of desmoteplase between 3-9 h after ischemic stroke onset did not improve clinical outcome; (2) at present neither lidocaine, erythropoietin or ropinotan had been effective neuroprotective agents in ischemic stroke; (3) treatment with dabigatran was associated with lower rate of stroke and systemic embolism in patients with non-valvular aerial fibrillation; (4) memantine and constraint-induced aphasia therapy were able to reduce the severity of aphasia in chronic post-stroke aphasia and (5) percutaneous closure of the left aerial appendage can be an effective alternative to chronic warfare treatment.