Stroke, Vol 15, 980-989, Copyright © 1984 by American Heart Association
T Strand, K Asplund, S Eriksson, E Hagg, F Lithner and PO Wester
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/l, 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 less than 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 less than 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.
ARTICLES
A randomized controlled trial of hemodilution therapy in acute ischemic stroke
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