Stroke, Vol 19, 464-471, Copyright © 1988 by American Heart Association
In a multicenter trial, 183 patients with acute ischemic stroke of less
than 48 hours' duration and hematocrits of 38-50% were randomized to
standardized hemodilution treatment (venesection and dextran 40
administration) and 190 to a control group. We have previously reported
that there were no beneficial effects of hemodilution in the total patient
population. In this report, the case fatality rates and neurologic outcome
in survivors (3 months' follow-up) in subsets of patients have been
analyzed. The patients were subgrouped by sex, age, medical history,
smoking habits, delay from the onset of symptoms to the start of treatment,
hematocrit at entry, venesection volume, neurologic score at entry into the
study, blood pressure changes in the acute phase, presence of atrial
fibrillation, location of brain lesion by computed tomography, type of
diagnostic procedures, and hospital setting. No subset in which
hemodilution reduced mortality or improved neurologic outcome could be
identified. Case fatality rate was apparently higher in hemodiluted
patients with infarction affecting deep brain structures than in control
patients with such lesions. By simple clinical criteria, we have been
unable to define subsets of stroke patients who benefit from the present
standardized regimen of moderate hemodilution. The sample sizes are,
however, too small to refute the possibility that a modest clinical effect
of hemodilution may be present in some patients with stroke.
ARTICLES
Multicenter trial of hemodilution in acute ischemic stroke. Results of subgroup analyses. Scandinavian Stroke Study Group
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