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- W2137022700 abstract "To the Editor: Dr del Zoppo et al are to be congratulated for successfully completing the first randomized, double-blind, controlled trial of intra-arterial pro-urokinase (pro-UK) in ischemic stroke (PROACT).1 A sophisticated route of administration of pro-UK by microcatheter into the thrombus was chosen in order to maximize lysis and minimize hemorrhagic side effects. Moreover, at the low infusion rate (6 mg over 2 hours) that was used, there is no systemic conversion of pro-UK to urokinase, and its effect is entirely fibrin specific. As a result, little or no bleeding should have occurred, because in stroke, bleeding is correlated with nonspecificity (ie, streptokinase induces more bleeding than tPA).In view of this prudent protocol, it is curious that intravenous heparin was given concomitantly with pro-UK in the treatment group or given alone in the placebo group.Early anticoagulation with heparin for ischemic stroke has long been considered hazardous, and it has been recommended that heparin be delayed for at least 48 hours after embolism.2 Even when heparin was administered by the subcutaneous route to patients with ischemic stroke, a 4-fold increase in hemorrhagic stroke was reported in the International Stroke Trial.3 Consequently, heparin has been scrupulously avoided in all of the clinical trials of tPA in stroke. Therefore, it is not surprising that …" @default.
- W2137022700 created "2016-06-24" @default.
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- W2137022700 date "1998-06-01" @default.
- W2137022700 modified "2023-09-27" @default.
- W2137022700 title "Intra-arterial Pro-urokinase in Ischemic Stroke" @default.
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- W2137022700 doi "https://doi.org/10.1161/01.str.29.6.1255" @default.
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