Randomized Clinical Stroke Trials In 2008

Problem statement: Stroke ranks as the third leading cause of death and the leading cause of serious, long-term disability; 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 pharmacotherapies 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 2008. 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 PubMed 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 hyperglycaemia, Hypertension OR raised blood pressure, Aspirin OR anti-platelets, Warfarin OR anticoagulant, Antidepressants, Neuroprotectants and Coiling OR stents OR endovascular. Search limits included Human, Adult (age >19 years), English language and Publication date: 1/1/2008 to 12/31/2008. Results: Eleven categories of 21 RCT’s were found and analyzed. Conclusion/Recommendations: There is sufficient evidence to suggest that: (1) extending the time-window for administration of alteplase from 3-4.5 h after stroke onset does improve clinical outcome; (2) treatment of hypertension in the elderly does reduce rate of stroke, cardiac failure and death from stroke and (3) at present there are no neuroprotectants on the horizon.