A randomized controlled trial of hemodilution therapy in acute ischemic stroke.

Abstract

SUMMARY Rapid hemodilution in the early phase of ischemic stroke by the combination of venesection (250-650 ml during the first 2 days) and administration of low-molecular weight dextran was evaluated in a prospective controlled trial. Fifty-two patients were randomized to hemodilution therapy and 50 to a control group; the two groups were comparable in important prognostic variables. Mean hemoglobin was reduced from 147 to 127 g/1, hematocrit from 43 to 37% and, in a subsample of patients, whole-blood viscosity at a shear rate of 23 sec' 1 from 7.0 to 4.3 cps over the first 2 days. Hemodilution was then maintained by repeated dextran infusions.Of the hemodiluted patients, 85% improved in neurological scoring over the first 10 days as compared to 64% of the control patients (p < 0.025). The case fatality rate during the first 3 months was little affected by hemodilution. Among the survivors, 8% of the hemodiluted and 31% of the non-hemodiluted patients were unable to walk at 3 months. The proportion of surviving patients still hospitalized at the 3-month follow-up was 13% in the hemodilution group and 39% in the control group (p < 0.01).The combination of venesection and dextran 40 administration is thus an unsophisticated but effective way to achieve rapid hemodilution in patients with acute cerebral infarction, and it improves the overall clinical outcome over the first 3 months.Stroke Vol 15, No 6, 1984

Baseline hemodynamic state and response to hemodilution in patients with acute cerebral ischemia.

“…This hypervolemic regimen resulted in no enlargement of heart size or clinical evidence of CHF in treated patients compared with controls. 4 Our data indicate that most patients with acute cerebral infarct who do not have clinical evidence of congestive heart failure have low PWP (mean 6.3 ± 3.5), therefore allowing hypervolemic hemodilution by administration of volume expanders before resorting to phlebotomy. Most patients do not eat or drink for several hours following their stroke while in transit to the hospital and undergoing evaluation and thus they are relatively volume depleted.…”

Evaluation of long-term outcome and safety after hemodilution therapy in acute ischemic stroke.

“…All patients recruited for the study were initially treated in the stroke unit of the Department of Medicine at Umea University Hospital. 1 Anemic patients (hemoglobin concentration of <120 g/1), patients with overt signs of acute left ventricular failure (significant pulmonary rales), and patients with acute myocardial infarction or unstable angina pectoris were excluded from randomization. Patients in a condition that could hamper proper evaluation of therapeutic effects, including patients in a coma, patients with neurological deficits lasting >48 hours, patients in the terminal stage of concomitant severe disorders, and patients with ongoing anticoagulant treatment, were also excluded.…”

“…The moderately hypervolemic hemodilution regimen applied induced a rapid and persistent reduction in hematocrit and whole blood viscosity without overt adverse hemodynamic effects. 1 All patients were treated in a stroke unit and received equal amounts of rehabilitation procedures. 2 In the majority of stroke patients, functional gains seem to be primarily a spontaneous event over time, 3 with the full potential for spontaneous recovery reached 6-12 months after the stroke.…”

Hemodilution for cerebral ischemia.

“…23 In this careful preliminary study 52 treated patients were compared with 51 randomly chosen control patients, all of whom were cared for in a specialized intensive care stroke unit. The Hct was brought down from an average of 43% to 37% over a 2-day period by venesection and infusions of LMD.…”