Guide Therapeutic Hemorheology

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Erythrocyte rheological properties but not whole blood and plasma viscosity are associated with severity of hypertension in older people. Z Gerontol Geriatr ; Effects of pentoxifylline on hemodynamic, hemorheological, and microcirculatory parameters in young SHRs during arterial hypertension development. Clin Exp Hypertens ; Hyperviscosity syndrome in arterial hypertension and hemorheological effects of antihypertensive drugs.

Russian J Cardiol ; Hemorheology and hemodynamics: Dove andare? Blood Press ; Haemorheological disturbances in hypertensive type 2 diabetic patients — Influence of antihypertensive therapy. Fundam Clin Pharmacol ; A substudy of the anglo-scandinavian cardiac outcomes trial. Am J Hypertens ; Influence of a calcium antagonist on blood rheology and arterial compliance in hypertension: Comparison with a thiazide diuretic.

Decreased blood viscosity and serum levels of erythropoietin after anti-hypertensive treatment with amlodipine or metoprolol: Results of a cross-over study. Improved insulin sensitivity by the angiotensin II-receptor blocker losartan is not explained by adipokines, inflammatory markers, or whole blood viscosity. Metabolism ; Simple linear regression was used to identify predictors of stroke outcome.

P value equal to or less than 0. This case control study included 30 subjects, 20 patients with acute ischemic stroke and 10 healthy volunteers as a control. In comparing patients and control groups regarding results of laboratory investigations, there was significant difference between patients and control groups regarding platelet aggregation being more in patients group and serum albumin being more in control group , p value 0.

There was a significant difference between the two groups only regarding serum albumin being more in patients with good outcome , p value 0. Correlation was carried between size of infarction and results of laboratory investigation. Antithrombin III, protein C, protein S, platelet aggregation, blood viscosity, hematocrit, total leukocyte count, and albumin were entered in regression model, but only albumin was found to be significant predictor for outcome Fig.

The early hours after an acute stroke are crucial; it is the most useful time for effective management. With the rising burden of stroke and marked heterogeneity in stroke manifestation and outcome, it is necessary to find accurate, reliable, and simple predictors of functional recovery.

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Hemorheology and peripheral vascular diseases: a new therapeutic approach. - Abstract - Europe PMC

Also, the natural recovery patterns must be investigated more so that we can better assess the effectiveness of the available therapeutic interventions and their contribution to recovery process Bhatia et al. In this study, we assessed the role of some important hemorheological parameters such as blood viscosity hematocrit Htc , platelet aggregation, and leukocyte count , protein C, protein S, antithrombin III, and serum albumin as prognostic factors which can early predict the outcome after ischemic stroke.

Albumin is an important functional protein in the blood; it maintains the normal permeability of the microvessel wall, reduces blood viscosity, and inhibits platelet aggregation Wei-Hai et al. In recent years, there has been increasing interest in the association between serum albumin levels and stroke.

Blood Viscosity:A Major Contributor to Diseases of Aging

Many studies have demonstrated an inverse relation between the concentration of serum albumin, stroke risk, and functional outcome Babu et al. Our results revealed that the serum albumin at admission is an independent predictive factor of the functional outcome in ischemic stroke patients by linear regression statistical analysis which is done to test for significant predictors of outcome. Many recent studies have shown the prognostic role of serum albumin level in cases of acute ischemic stroke.

Our results agreed with Wei-Hai et al. They concluded that serum level of albumin at admission is considered as a good indicator of the functional outcome and trials for the correction of hypoalbuminemia in acute ischemic stroke would be helpful to decrease the risk of poor outcome.

Belayev et al. High-dose albumin treatment for acute ischemic stroke was assessed in a randomized, double-blind, placebo-controlled trial, and the results were not encouraging further studies to test the role of albumin on a larger scale, at a different dose, and over a longer duration of follow-up were suggested by the authors Ginsberg et al. In the present study, there was a statistically significant negative correlation between hematocrit and clinical outcome. An elevated hematocrit can enhance atherosclerosis by increasing protein infiltration into the vessel wall, promoting platelet adhesion to the subendothelium and by causing stagnation of blood flow Irace et al.

Our results agreed with Levy et al. Czlonkowska et al. On the other hand, our results were opposed by Ozaita et al. However, their findings also showed that there was only a tendency to elevated hematocrit in the first days in cases with severe admission deficit. Moreover, Bhatia et al. The importance of the effect of hematocrit on stroke outcome explains the role of hemodilution therapies that may potentially improve stroke outcome.

Previous hemodilution strategies have aimed to increase cerebral blood flow and salvage penumbral tissue. Unfortunately, early hemodilution trials in management of human acute ischemic stroke were negative, and the failure of translation from the trials of animal models has been attributed to different time windows and methodologic limitations in human Asplund Leukocyte count has an established role in predicting incident cerebrovascular and cardiovascular diseases, but the relationship between leukocyte count and acute ischemic stroke outcome is not well investigated Elkind et al.

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Our results agreed with many recent studies; Furlan et al. Also, survival curves showed that high leukocyte count was associated with worsening in the day mortality in patients with acute ischemic stroke. Also, Liang et al. Our study disagrees with an older study which studied the effect of leukocytosis on stroke outcome and reported that increased total leukocyte count on admission was related only to initial stroke severity but not to functional outcome Kammersgaard et al.

Blood viscosity assumes a vital role in the pathophysiology of vascular diseases as a factor determining global cardiovascular load, and as a variable influencing regional tissue perfusion. Additionally, a high blood viscosity increases the risk of thromboembolic events and is correlated with the presence of systemic inflammation Pop et al. This result was agreed with Zhou and Yang who reported that blood viscosity has positive correlation with the size of the cerebral infarction and postulated that the hematocrit and the blood viscosity should be reduced immediately for treating the larger cerebral infarction.

Platelet aggregation is a vital step in thrombus formation; several studies have demonstrated that platelets are activated in the acute phase of ischemic stroke. However, the impact of enhanced platelet activation in the clinical and functional outcome of acute ischemic stroke was still not well investigated. Recently, many studies have demonstrated that enhanced platelet activation is related to larger infarct size and poor clinical and functional outcome in patients with acute ischemic stroke Zeller et al. This study found a significant difference between cases and control group as regard platelet aggregation p value 0.

Hemorheology

Also systemic platelet activation is enhanced in patients with acute stroke or TIA and returns to baseline levels at 3-month follow-up. Moreover, at 3-month follow-up, persistent platelet activation is associated with increased incidence of recurrent stroke. However, in this study, there was no statistically significant correlation between platelet aggregation and clinical outcome.

This finding coincided with Bhatia et al. On the contrary, Iwamoto et al. The role of the natural anticoagulants, antithrombin III, protein C, and protein S, in patients with ischemic stroke, remains uncertain. This study aimed to find out whether their levels in peripheral blood correlate with the severity of neurological deficit or can predict clinical outcome and recurrence. There was no significant correlation between antithrombin III, protein C, and protein S and stroke outcome. Additionally, natural anticoagulants deficiency is considered as one of the main risk factors of venous infarctions with less clear role in arterial infarctions.

Our results partially coincided with Haapaniemi et al. Moreover, natural anticoagulant levels did not predict recurrence of ischemic stroke. At the end of this study, we conclude that decreased serum albumin, increased hematocrit level, and increased total leukocyte count at the time of presentation of ischemic stroke are associated with less favorable outcome, while antithrombin III, protein s, protein c, platelet aggregation or blood viscosity have no clear role in stroke outcome.

The limitation of this work is the relatively small number of patients due to the limitation of resources and financial issues. Further studies should be conducted on a larger number of patients and for a longer duration to estimate the remote outcome and to study the effect of correction of hypoalbuminemia and the effect of hemodilution therapies on stroke outcome. Elevated hematocrit is associated with reduced reperfusion and tissue survival in acute stroke.

Percent change on the National Institutes of Health Stroke Scale: a useful acute stroke outcome measure. J Stroke Cerebrovasc Dis. Asplund K. Haemodilution for acute ischaemic stroke Cochrane Review. In: The Cochrane Library, ; Issue 1. Chichester: Wiley.

Predictors of stroke outcome: the role of hemorheology, natural anticoagulants, and serum albumin

Serum albumin levels in ischemic stroke and its subtypes: correlation with clinical outcome. Human albumin therapy of acute ischemic stroke: marked neuroprotective efficacy at moderate doses and with a broad therapeutic window.


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About this book Introduction Hemorheologic therapy has gained considerably in importance in recent years. This detailed and comprehensive book enumerates, discusses, and critically evaluates those treatment methods in which therapeutic success rests essentially on achieving an improvement in hemodynamics. After a general account of clinical hemorheology, fundamental aspects of hemorheologic methods and the eval- uation and assessment of hemorheologic parameters are discussed and the pathophysiology is described in detail.


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The treatment methods and substances that bring about improvement of the hemodynamics are described in chronologic order of first publication, and in each case all known later publications are also discussed in the order in which they appeared.