Hyperglycemia, Acute Ischemic Stroke, and Thrombolytic Therapy

Sherif Hafez, Maha Coucha, Askiel Bruno, Susan C. Fagan, Adviye Ergul

Research output: Contribution to journalReview article

60 Citations (Scopus)

Abstract

Ischemic stroke is a leading cause of disability and is considered now the fourth leading cause of death. Many clinical trials have shown that stroke patients with acute elevation in blood glucose at onset of stroke suffer worse functional outcomes, longer in-hospital stay, and higher mortality rates. The only therapeutic hope for these patients is the rapid restoration of blood flow to the ischemic tissue through intravenous administration of the only currently proven effective therapy, tissue plasminogen activator (tPA). However, even this option is associated with the increased risk of intracerebral hemorrhage. Nonetheless, the underlying mechanisms through which hyperglycemia (HG) and tPA worsen the neurovascular injury after stroke are not fully understood. Accordingly, this review summarizes the latest updates and recommendations about the management of HG and coadministration of tPA in a clinical setting while focusing more on the various experimental models studying (1) the effect of HG on stroke outcomes, (2) the potential mechanisms involved in worsening the neurovascular injury, (3) the different therapeutic strategies employed to ameliorate the injury, and finally, (4) the interaction between HG and tPA. Developing therapeutic strategies to reduce the hemorrhage risk with tPA in hyperglycemic setting is of great clinical importance. This can best be achieved by conducting robust preclinical studies evaluating the interaction between tPA and other therapeutics in order to develop potential therapeutic strategies with high translational impact.

Original languageEnglish (US)
Pages (from-to)442-453
Number of pages12
JournalTranslational Stroke Research
Volume5
Issue number4
DOIs
StatePublished - Aug 1 2014

Fingerprint

Thrombolytic Therapy
Tissue Plasminogen Activator
Hyperglycemia
Stroke
Wounds and Injuries
Therapeutics
Cerebral Hemorrhage
Intravenous Administration
Blood Glucose
Cause of Death
Length of Stay
Theoretical Models
Clinical Trials
Hemorrhage
Mortality

Keywords

  • Experimental models
  • Hyperglycemia
  • Stroke
  • Thrombolysis
  • Tissue plasminogen activator (tPA)
  • Vascular reactivity

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Hyperglycemia, Acute Ischemic Stroke, and Thrombolytic Therapy. / Hafez, Sherif; Coucha, Maha; Bruno, Askiel; Fagan, Susan C.; Ergul, Adviye.

In: Translational Stroke Research, Vol. 5, No. 4, 01.08.2014, p. 442-453.

Research output: Contribution to journalReview article

Hafez, Sherif ; Coucha, Maha ; Bruno, Askiel ; Fagan, Susan C. ; Ergul, Adviye. / Hyperglycemia, Acute Ischemic Stroke, and Thrombolytic Therapy. In: Translational Stroke Research. 2014 ; Vol. 5, No. 4. pp. 442-453.
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