Safety and Effect of Continuous Intravenous Urokinase Therapy in Acute Ischemic Stroke ( Open Clinical Trial )

Doh, Wha Beum; Lee, Byung Chul; Lee, Il Hyung; Kim, Sung Min; Kwon, Ki Han

Abstract

BACKGROUND: Early thrombolysis with intra-arterial urokinase(UK) or intravenous(IV) t-PA may be beneficial for patients with acute ischemic stroke, but this therapy is unavailable in some circumstances and cannot be applied in the cases of late admission. Thus, continuous IV UK infusion has been applied empirically in many hospitals of our country. However, the therapeutic efficacy of this therapy is not known yet. In this study, we investigated the safety and the clinical effect of continuous IV UK infusion. METHOD: 68 patients with acute supratentorial ischemic stroke within 3 days of onset received 6 x 105units of UK daily by continuous infusion for 5 days without loading dose. We estimated European stroke scale (ESS) and Barthel index score (BIS) prior to therapy, on day 1, 3 and 7 after the start of UK, and on the day of discharge.
RESULTS
The ESS and BIS were improved in most patients after the therapy. There are no differences in therapeutic effects among the various stroke subtypes and the starting times of therapy after onset. Out of 10 TIA patients, 9 patients did not undergo further TIA and only one patient had complete infarction during UK infusion. Complications were noted in 7(10.3%) patients. But these complications were all minimal.
CONCLUSION
As this study was just an open clinical trial, we could not conclude about definite efficacy of continuous IV UK infusion in acute ischemic stroke. However, this therapy might be at least acceptable safe regimen and deserves to be performed in multicenter double-blind controlled trials to clarify the efficacy.