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Analytic Reviews : Hypervolemic Hemodilution in Acute Ischemic Stroke

Division of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322

David B. Kee, JR, MD

Division of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322

In patients with acute ischemic stroke, reversibility of the neurologic deficits depends on the depth and dura tion of the ischemic insult. The rapid elevation of cere bral blood flow (CBF) above ischemic thresholds may minimize or prevent infarction. Reduction of blood vis cosity has been shown to augment CBF and improve cerebral neuronal activity after stroke. Hypervolemic hemodilution decreases hematocrit, increases blood volume, augments cardiac output, and, in randomized clinical trials, improves the long-term outcome in acute ischemic stroke. Similarly, administration of drugs that decrease plasma fibrinogen and increase erythrocyte flexibility reportedly causes a decrease in the incidence of recurrent ischemia after an initial transient ischemic attack. Thus, the pharmacologic manipulation of blood viscosity appears to be effective in managing patients with acute ischemic stroke.

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