Stroke, Vol 18, 691-699, Copyright © 1987 by American Heart Association
Hemodilution by the combination of venesection and dextran 40
administration has previously been reported to enhance neurologic recovery
in the acute phase of ischemic stroke. To study this therapeutic principle
in its "natural habitat," a stratified and randomized multicenter trial
involving 15 large and small hospitals was performed. Patients with acute
ischemic stroke of less than 48 hours' duration and with hematocrits of
38-50% on admission were randomized to a hemodilution (183 patients, mean
age 72.0 years) or a control group (190 patients, mean age 71.6 years). The
two groups did not differ in sex distribution or medical history.
Hematocrit, blood pressure, and neurologic score were closely similar at
entry. By graded venesection (250-1000 ml) during the first 2 days and
dextran 40 infusions (500 ml daily) during 5 days, the mean hematocrit was
reduced from 44.2 to 37.1%. Three-month survival expressed as life table
product was 0.84 in hemodilution and 0.88 in control patients. In
survivors, neurologic score and activities of daily living performance
during 3 months of follow-up were not improved by hemodilution. Length of
stay in an acute- care hospital and the need for long-term institutional
care was not reduced among patients in the hemodilution group. Major
cardiovascular events occurred somewhat more often and there was an
apparent increase in mortality during the first few days of hemodilution
therapy. However, the differences were not significant. We conclude that
the present standardized treatment with moderate hemodilution has no
overall beneficial effects in general patients with acute ischemic stroke.
ARTICLES
Multicenter trial of hemodilution in acute ischemic stroke. I. Results in the total patient population. Scandinavian Stroke Study Group
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