Pharmacological management options to prevent and reduce ischemic hemorrhagic transformation

Wing Mann Ho; Cesar Reisa; Onat Akyol; Gokce Yilmaz Akyol; Richard Applegate; Gary Stier; Robert Martin; John H. Zhang

doi:10.2174/1389450117666160818115850

Pharmacological management options to prevent and reduce ischemic hemorrhagic transformation

Wing Mann Ho
, Cesar Reisa
, Onat Akyol
, Gokce Yilmaz Akyol
, Richard Applegate
, Gary Stier
, Robert Martin
, John H. Zhang

Research output: Contribution to journal › Review article › peer-review

Abstract

BACKGROUND: Hemorrhagic transformation (HT) is a common and natural complication after acute ischemic stroke. The only FDA-approved treatment so far for acute ischemic stroke is rapid reperfusion with recombinant tissue plasminogen activator (rtPA). Although it has been shown to exaggerate the risk and severity of HT and to be associated with increased morbidity and mortality.

OBJECTIVE: The aim of this review is to discuss the multifactorial pathophysiology of hemorrhagic transformation, promising interventional targets, and pharmacological treatment options.

RESULTS AND CONCLUSION: Understanding HT is essential to restore cerebral blood flow to ischemic brain by reperfusion therapy without causing this complication and additional brain injury. Therefore methods for the prevention and treatment of HT are needed. Although experimental studies showed promising results, clinical translation remains unsatisfactory to date.

Original language	English
Pages (from-to)	1441-1459
Number of pages	19
Journal	Current Drug Targets
Volume	18
Issue number	12
DOIs	https://doi.org/10.2174/1389450117666160818115850
State	Published - Dec 2017

ASJC Scopus Subject Areas

Molecular Medicine
Pharmacology
Drug Discovery
Clinical Biochemistry

Keywords

Cerebral ischemia
Conversion
Hemorrhagic transformation
Prevention
Stroke
Treatment
Reactive Oxygen Species/metabolism
Humans
Fibrinolytic Agents/pharmacology
Signal Transduction/drug effects
Vascular Endothelial Growth Factor A/metabolism
Matrix Metalloproteinases/metabolism
Animals
Brain Ischemia/complications
Cerebral Hemorrhage/metabolism
Disease Models, Animal

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title = "Pharmacological management options to prevent and reduce ischemic hemorrhagic transformation",

abstract = "BACKGROUND: Hemorrhagic transformation (HT) is a common and natural complication after acute ischemic stroke. The only FDA-approved treatment so far for acute ischemic stroke is rapid reperfusion with recombinant tissue plasminogen activator (rtPA). Although it has been shown to exaggerate the risk and severity of HT and to be associated with increased morbidity and mortality.OBJECTIVE: The aim of this review is to discuss the multifactorial pathophysiology of hemorrhagic transformation, promising interventional targets, and pharmacological treatment options.RESULTS AND CONCLUSION: Understanding HT is essential to restore cerebral blood flow to ischemic brain by reperfusion therapy without causing this complication and additional brain injury. Therefore methods for the prevention and treatment of HT are needed. Although experimental studies showed promising results, clinical translation remains unsatisfactory to date.",

keywords = "Cerebral ischemia, Conversion, Hemorrhagic transformation, Prevention, Stroke, Treatment, Reactive Oxygen Species/metabolism, Humans, Fibrinolytic Agents/pharmacology, Signal Transduction/drug effects, Vascular Endothelial Growth Factor A/metabolism, Matrix Metalloproteinases/metabolism, Animals, Brain Ischemia/complications, Cerebral Hemorrhage/metabolism, Disease Models, Animal",

author = "Ho, \{Wing Mann\} and Cesar Reisa and Onat Akyol and Akyol, \{Gokce Yilmaz\} and Richard Applegate and Gary Stier and Robert Martin and Zhang, \{John H.\}",

note = "Publisher Copyright: {\textcopyright} 2016 Bentham Science Publishers.",

year = "2017",

month = dec,

doi = "10.2174/1389450117666160818115850",

language = "English",

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T1 - Pharmacological management options to prevent and reduce ischemic hemorrhagic transformation

AU - Ho, Wing Mann

AU - Reisa, Cesar

AU - Akyol, Onat

AU - Akyol, Gokce Yilmaz

AU - Applegate, Richard

AU - Stier, Gary

AU - Martin, Robert

AU - Zhang, John H.

PY - 2017/12

Y1 - 2017/12

N2 - BACKGROUND: Hemorrhagic transformation (HT) is a common and natural complication after acute ischemic stroke. The only FDA-approved treatment so far for acute ischemic stroke is rapid reperfusion with recombinant tissue plasminogen activator (rtPA). Although it has been shown to exaggerate the risk and severity of HT and to be associated with increased morbidity and mortality.OBJECTIVE: The aim of this review is to discuss the multifactorial pathophysiology of hemorrhagic transformation, promising interventional targets, and pharmacological treatment options.RESULTS AND CONCLUSION: Understanding HT is essential to restore cerebral blood flow to ischemic brain by reperfusion therapy without causing this complication and additional brain injury. Therefore methods for the prevention and treatment of HT are needed. Although experimental studies showed promising results, clinical translation remains unsatisfactory to date.

AB - BACKGROUND: Hemorrhagic transformation (HT) is a common and natural complication after acute ischemic stroke. The only FDA-approved treatment so far for acute ischemic stroke is rapid reperfusion with recombinant tissue plasminogen activator (rtPA). Although it has been shown to exaggerate the risk and severity of HT and to be associated with increased morbidity and mortality.OBJECTIVE: The aim of this review is to discuss the multifactorial pathophysiology of hemorrhagic transformation, promising interventional targets, and pharmacological treatment options.RESULTS AND CONCLUSION: Understanding HT is essential to restore cerebral blood flow to ischemic brain by reperfusion therapy without causing this complication and additional brain injury. Therefore methods for the prevention and treatment of HT are needed. Although experimental studies showed promising results, clinical translation remains unsatisfactory to date.

KW - Cerebral ischemia

KW - Conversion

KW - Hemorrhagic transformation

KW - Prevention

KW - Stroke

KW - Treatment

KW - Reactive Oxygen Species/metabolism

KW - Humans

KW - Fibrinolytic Agents/pharmacology

KW - Signal Transduction/drug effects

KW - Vascular Endothelial Growth Factor A/metabolism

KW - Matrix Metalloproteinases/metabolism

KW - Animals

KW - Brain Ischemia/complications

KW - Cerebral Hemorrhage/metabolism

KW - Disease Models, Animal

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U2 - 10.2174/1389450117666160818115850

DO - 10.2174/1389450117666160818115850

M3 - Review article

C2 - 27538508

SN - 1389-4501

VL - 18

SP - 1441

EP - 1459

JO - Current Drug Targets

JF - Current Drug Targets

IS - 12

ER -

Pharmacological management options to prevent and reduce ischemic hemorrhagic transformation

Abstract

ASJC Scopus Subject Areas

Keywords

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