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Patients with acute ischemic stroke were randomized<24 hours after onset to standard(S)therapy(n=43)or to hypervolemic hemodilution(HH)with pentastarch(n=45).The therapeutic goal of hypervolemic hemodilution was to rapidly reduce hematocrit to 33%,to raise cardiac output,and to continue hypervolemic hemodilution for 3 days.A graded neurologic examination was scored by a blinded observer at randomization(baseline),at the end of treatment or after 72 hours,and at a 3-month follow-up;each patient was also rated using Barthel's disability scale at the 3-month follow-up.Group demographics and results of the graded neurologic examination were similar at baseline,except that the HH group contained twice the number of patients with severe strokes and fewer patients randomized within 12 hours compared with the S group.The HH group improved an average of 7 points in neurologic score from baseline to the end of treatment(the S group deteriorated 1 point)and 24 points by the 3-month follow-up(the S group improved 15 points;p=0.11).The HH group reached an average Barthel disability scale index of 85 while the S group averaged 70(p=0.8).Deaths associated with cerebral edema occurred in five patients with severe stroke(four in the HH group vs.one in the S group,p=0.36).The following subgroups of HH patients showed better overall improvement in neurologic scores:patient entered within 12 hours after stroke onset,patients with a 15%decrease in hematocrit,and patients with a 10%increase in cardiac output.Based on these results,we conclude that further evaluation of hypervolemic hemodilution using refined patient selection techniques and improved study design is indicated. |
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