Treatment of acute ischemic stroke in patients with and without atrial fibrillation

In the Netherlands, 21.000 patients per year are struck by an ischemic stroke. Stroke is a major cause of death and an important cause of hospital admission and long-term disability. Although case-fatality rates have steadily declined over the past 25 years, this is mainly due to improved general stroke management but not to new strategies to halt or reverse the harmful effects of brain ischemia. Stroke as a clinical syndrome was recognized even before the time of Hippocrates, but it was not until I 995 that the first effective treatment, thrombolysis with recombinant tissue plasminogen activator, became available. However, this treatment can be applied only to a small percentage of patients. For all others cases no effective treatment is available. In this thesis I shall describe and discuss two types of treatment for acute ischemic stroke, that were studied in randomized controlled trials. Firstly, we evaluated the safety, efficacy and pharmacodynamics of the use of a hemoglobin solution, diaspirin cross-linked hemoglobin (DCLHb) in a multicenter trial of patients with acute ischemic stroke. Secondly, we studied the effect of heparin in patients with acute ischemic stroke in combination with atrial fibrillation (AF) entered in a large clinical study, the International Stroke Trial (IST). We had specific interest in the prevention of early stroke recurrence

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