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. 2004;2004(3):CD000177.
doi: 10.1002/14651858.CD000177.pub2.

Prostacyclin and analogues for acute ischaemic stroke

P M W Bath  1
Affiliations

Prostacyclin and analogues for acute ischaemic stroke

P M W Bath. Cochrane Database Syst Rev. 2004.

Abstract

Background: Prostacyclin is an agent with a number of effects on platelets, blood vessels and nerve cells which might improve outcome after acute ischaemic stroke. NOTE: This review covers an area where no active research is taking place. It will be updated if relevant information becomes available, e.g. on completion of an appropriate study.

Objectives: The objective of this review was to assess the effect of prostacyclin or analogues on survival in people with acute ischaemic stroke.

Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched November 2003). For the first version, we also searched EMBASE (1980 to 1999), MEDLINE (1966 to 1999), Science Citation Index (1981 to 1999) and the Ottawa Stroke Trials Registry. We also contacted the manufacturers of prostacyclin and the principal investigators of the identified trials.

Selection criteria: Randomised trials comparing prostacyclin or analogues with placebo or control. Trials where people were entered within one week of stroke onset were included.

Data collection and analysis: Information on the methods of randomisation, blinding, analysis, the number of patients randomised, dose and timing of prostacyclin or analogue, patient withdrawals, the number of deaths occurring in each trial, and trial quality, were collected and assessed.

Main results: Five trials involving 191 people were included. Six early deaths (within four weeks) occurred with prostacyclin, and nine with placebo (odds ratio (OR) 0.63, 95% confidence interval (CI) 0.22 to 1.85). One trial of 32 patients reported late deaths (by 10 to 18 months) in 50% of patients in each group.

Reviewers' conclusions: Too few patients have been studied in randomised trials to allow conclusions to be drawn about the effect of prostacyclin treatment on survival of people with acute stroke.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Prostacyclin vs control in ischaemic stroke: all trials, Outcome 1 All cause case fatality, early (within 4 weeks).
1.2
1.2. Analysis
Comparison 1 Prostacyclin vs control in ischaemic stroke: all trials, Outcome 2 All cause case fatality, late (up to 18 months).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Hsu 1986 {published and unpublished data}
    1. Hsu CY, Faught Jn RE, Furlan AJ, Coull BM, Huang EL, Hogan EL, et al. Intravenous prostacyclin in acute nonhemorrhagic stroke: a placebo‐controlled double‐blind trial. Stroke 1986;18:352‐8. - PubMed
    1. Kent IC, Huang DC, Linet OI. Randomized, controlled clinical trial of Cyclo‐prostin (epoprostenol, prostacyclin, PGI2) in acute atherothrombotic strokes and embolic strokes of cardiac origin (multi‐clinic protocol 1088 ‐ Investigators: Drs Coull, Faught, Furlan, Hogan, and Yatsu). Upjohn Company Technical Report 7250/85/007 1985.
    1. Linet O, Hsu CY, Faught RE, Hogan EL, Furlan AJ, Coull BM, et al. Epoprostenol in acute stroke. Stroke 1985;16:149.
    1. Yatsu FM, Grotta JC, Pettigrew LC, Gray CS. Prostacylin infusion for acute ischaemic strokes: Results of a double‐blind study. In: Battistini N, Fiorani P, Courbier R, Plum F, Fieschi C editor(s). Acute brain ischaemia: medical and surgical therapy. 1st Edition. New York: Raven Press, 1986:263‐271.
    1. Yatsu FM, Grotta JC, Pettigrew LC, Gray JD, Hogan EL, Hsu CY, et al. Prostacyclin infusions in acute ischaemic strokes. Royal Society of Medicine Services International Congress and Symposium Series No 99. In: Clifford Rose F editor(s). Stroke: epidemiological, therapeutic and socio‐economic aspects. 1st Edition. London: Royal Society of Medicine Services Limited, 1986:73‐9.
Huczynski 1985 {published data only}
    1. Huczynski J, Kostka‐Trabka E, Sotowska W, Bieron K, Grodzinska L, Dembinska‐Kiec A, et al. Double‐blind controlled trial of the therapeutic effects of prostacyclin in patients with completed ischaemic stroke. Stroke 1985;16:810‐4. - PubMed
Huczynski 1988 {published data only}
    1. Huczynski J, Gryglewski RJ, Kostka‐Trabka E, Dembinska‐Kiec A, Pykosz‐Mazur E, Sotowska W, et al. Use of prostacyclin in patients with ischemic stroke. A double‐blind method II. Neurologia i Neurochirurgia Polska 1988;22:299‐304. - PubMed
Martin 1985 {published data only}
    1. Hamdy NAT, Martin JF, Nicholl J, Owen P, Lewtas N, Bergvall UB, et al. Controlled trial of prostacyclin in acute cerebral infarction. Clinical Science 1984;66 (Suppl):48P.
    1. Martin JF, Hamdy N, Nicholl J, Lewtas N, Bergvall U, Owen P, et al. Prostacyclin in cerebral infarction. New England Journal of Medicine 1985;312:1642. - PubMed
    1. Martin JF, Handy N, Nicholl J, Lewtas N, Bergvall U, Owen P, et al. Double‐blind controlled trial of prostacyclin in cerebral infarction. Stroke 1985;16:386‐90. - PubMed
Pokrupa 1986 {published and unpublished data}
    1. Pokrupa A, Hakim J, Villanueva G, Francis G, Wolfe L. Clinical study of prostacyclin infusion after acute ischemic stroke. Canadian Journal of Neurological Sciences 1986;13:165.
    1. Pokrupa R, Hakim A, Villanueva J, Meyer E, Diksic M, Evans A. PET evaluation of blood flow and metabolic changes induced by PGI2 therapy in patients with ischemic stroke. Canadian Journal of Neurological Sciences 1986;13:188.
    1. Pokrupa RP, Hakim AM, Villanueva JA, Diksic M, Evans AE, Meyer E, et al. Prostacyclin infusion after acute cerebral infarction: clinical and PET studies. Unpublished manuscript.

References to studies excluded from this review

Hakim 1984 {published data only}
    1. Hakim AM, Pokrupa RP, Wolfe LS. Preliminary report on the effectiveness of prostacylin in stroke. Canadian Journal of Neurological Sciences 1984;11(3):409 (abstract).
Hoshi 1990 {published data only}
    1. Hoshi K, Mizushima Y. A preliminary double‐blind cross‐over trial of lipo‐PGI2, a prostacyclin derivative incorporated in lipid microspheres, in cerebral infarction. Prostaglandins 1990;40(2):155‐63. - PubMed
Isaka 1990 {published data only}
    1. Isaka Y, Imaizumi M, Mieno M, Uehara A, Hashikawa K, Handa N, et al. Potency of TRK‐100 (oral active prostacyclin analogue) as an antiplatelet agent as assessed by indium 111 platelet scintigraphy. Stroke 1990;21(suppl 1)(8):I‐160 (abstract).
Mizushima 1994 {published data only}
    1. Mizushima Y, Toyota T, Okita K, Ohtomo E. Recent clinical studies on lipo‐PGE1 and lipo‐PGI2: PGE1 and PGI2 incorporated in lipid microspheres, for targeted delivery. Journal of Controlled Release 1994;28:243‐9.
Zhao 1991 {published data only}
    1. Zhao J. Treatment of acute cerebral infarction with PGI2 ‐ evaluating the clinical effect and observation of dynamic changes in plasma TXB2 and 6‐keto PGF1 alpha levels. Chung Hua Shen Ching Ching Shen Ko Tsa Chih 1991;24:138‐40. - PubMed

Additional references

Akopov 1992
    1. Akopov S, Ghazarian A, Gabrielian E. Effects of nimodipine and nicergolin on cerebrovascular injuries induced by activation of platelets and leukocytes in vivo. Archives Internationales de Pharmacodynamie et de Therapie 1992;318:66‐75. - PubMed
Bath 1991
    1. Bath PMW, Hassall DG, Gladwin A‐M, Palmer RMJ, Martin JF. Nitric oxide and prostacyclin. Divergence of inhibitory effects on monocyte chemotaxis and adhesion to endothelium in vitro. Arteriosclerosis and Thrombosis 1991;11:254‐60. - PubMed
Bath 1995
    1. Bath PMW, Bath FJ. Blood pressure management in acute stroke. Cochrane Database of Systematic Reviews 1995, Issue 2.
Brown 1982
    1. Brown MM, Pickles H. Effect of epoprostenol (prostacyclin, PGI2) on cerebral blood flow in man. Journal of Neurology Neurosurgery and Psychiatry 1982;45:1033‐6. - PMC - PubMed
Chen 1986
    1. Chen ST, Hsu CY, Hogan EL, Halushka PV, Linet OI, Yatsu FM. Thromboxane, prostacyclin, and leukotrienes in cerebral ischemia. Neurology 1986;36:466‐70. - PubMed
Cook 1983
    1. Cook PJ, Maidment CG, Dandona P, et al. The effect of intravenous epoprostenol (prostacyclin, PGI2) on cerebral blood flow and cardiac output in man. British Journal of Clinical Pharmacology 1983;16:707‐11. - PMC - PubMed
Gryglewski 1982
    1. Gryglewski RJ, Nowak S, Kostka‐Trabka E, Bieron K, Dembinska‐Kiec A, Blaszczyk B, Kusmiderski J, Markowska E, Szmatola S. Clinical use of prostacyclin (PGI2) in ischaemic stroke. Pharmacological Research Communications 1982;14:879‐908. - PubMed
Gryglewski 1983
    1. Gryglewski RJ, Nowak S, Kostka‐Trabka E, Kusmiderski J, Dembinska‐Kiec A, Bieron K, et al. Treatment of ischaemic stroke with prostacyclin. Stroke 1983;14:197‐202. - PubMed
Martindale 1993
    1. Reynolds JEF (ed). Martindale, the extra pharmacopoeia. 30th Edition. London: The Pharmaceutical Press, 1993.
Miller 1984
    1. Miller VT, Coull BM, Yatsu FM, Shah AB, Beamer NB. Prostacyclin infusion in acute cerebral infarction. Neurology 1984;34:1431‐5. - PubMed
Miller 1985
    1. Miller VT, Coull BM, Yatsu FM, Shah AB, Beamer NB. Prostacyclin therapy for acute stroke. In: Plum F, Pulsinelli W editor(s). Cerebrovascular Diseases. New York: Raven Press, 1985:235‐9.
Moncada 1983
    1. Moncada S. Biology and therapeutic potential of prostacyclin. Stroke 1983;14:157‐68. - PubMed
Sinzinger 1981
    1. Sinzinger H, Silberbauer K, Horsch AK, Gall A. Decreased sensitivity of human platelets to PGI2 during long‐term intra‐arterial PGI2 infusion in patients with peripheral vascular disease ‐ a rebound phenomenon?. Prostaglandins 1981;21:49‐51. - PubMed

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