Reducing Haemorrhagic Transformation after Thrombolysis for Stroke: A Strategy Utilising Minocycline

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.

Inflammatory markers in pediatric stroke: An attempt to better understanding the pathophysiology

“…21 Efficacy and safety of adding minocycline to rtPA in patients is currently evaluated in Australian prospective multicenter study. 22 The fact that we observe an activation of MMP-9 in childhood stroke supports the idea that children might also profit from this add-on therapy.…”

Minocycline: A Novel Stroke Therapy

“…With the present knowledge about the efficacy of minocycline in reducing the effects of ischemic strokes the authors of the West Australian study known as the Intravenous Minocycline and TPA Stroke Study (WAIMATSS) [68] concluded that: "Minocycline has practical advantages, including its well-established track record of safety (when used as an antibiotic), bioavailability (including orally), and the fact that it can be safely used in patients with hemorrhagic stroke. This makes it a candidate for use in the prehospital setting, without the need for imaging prior to administration.…”

“…A study of the effect of administration of minocycline to patients with ischemic stroke is in progress [68]. The purpose of the study is to find out if the risk of ischemic strokes to convert into hemorrhagic strokes is reduced from administration of minocycline.…”

Combination therapy for ischemic stroke: Novel approaches to lengthen therapeutic window of tissue plasminogen activator

“…[ 46 ] Various other clinical trials with varying populations have been initiated and pending results. [ 47 ]…”