Reducing haemorrhagic transformation after thrombolysis for stroke: a strategy utilising minocycline - PubMed (original) (raw)

Reducing haemorrhagic transformation after thrombolysis for stroke: a strategy utilising minocycline

David J Blacker et al. Stroke Res Treat. 2013.

Abstract

Haemorrhagic transformation (HT) of recently ischaemic brain is a feared complication of thrombolytic therapy that may be caused or compounded by ischaemia-induced activation of matrix metalloproteinases (MMPs). The tetracycline antibiotic minocycline inhibits matrix MMPs and reduces macroscopic HT in rodents with stroke treated with tissue plasminogen activator (tPA). The West Australian Intravenous Minocycline and TPA Stroke Study (WAIMATSS) aims to determine the safety and efficacy of adding minocycline to tPA in acute ischaemic stroke. The WAIMATSS is a multicentre, prospective, and randomised pilot study of intravenous minocycline, 200 mg 12 hourly for 5 doses, compared with standard care, in patients with ischaemic stroke treated with intravenous tPA. The primary endpoint is HT diagnosed by brain CT and MRI. Secondary endpoints include clinical outcome measures. Some illustrative cases from the early recruitment phase of this study will be presented, and future perspectives will be discussed.

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Figures

Figure 1

Figure 1

Subject presented with acute left hemiparesis, leg more affected than arm. Routine day one CT (a) and day 5 MRI (b) demonstrate a small haemorrhage in the left temporal lobe, away from the main area of infarction, shown on diffusion weighted MRI (c) and (d), mainly in the territory of the right anterior cerebral artery. No clinical deterioration was detected.

Figure 2

Figure 2

Subject presented with mild left hemiparesis. The day one CT (a) and (b) shows a small infarct in the right subcortical white matter, with a suggestion of increased signal within the central portion. The gradient echo (c) and susceptibility weighted image (d) MRI sequences performed on day seven suggest a small amount of blood within the infarct. No clinical deterioration was detected.

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