Drug Cuts Damage, Death from Brain Bleeding

A single dose of a drug already used to treat hemophilia can help limit brain damage caused by the deadliest and most debilitating form of stroke, according to results of an international study released on Wednesday.

Chief author Stephan Mayer said he was “stunned” by the finding involving the drug recombinant activated factor VII, which is sold for hemophilia treatment under the brand name NovoSeven by Denmark’s Novo Nordisk. The study, which Novo Nordisk financed, also found the drug posed a “small” risk of causing a heart attack or another type of stroke. Its use as a stroke treatment is still regarded as experimental. “By preventing just 5 milliliters of additional blood — about one teaspoon — of bleeding in the brain, we were able to increase the chances of patient survival by nearly 40 percent,” said Mayer, of Columbia University College of Physicians and Surgeons. Strokes caused when a blood vessel breaks and releases blood into the brain, called acute intracerebral hemorrhage (ICH), are the deadliest. As many as half of those stricken die within a month and only one in five become independent again. ICH affects 15 percent of all stroke victims in the United States, or some 70,000 cases a year. In other parts of the world the incidence of bleeding stroke is even higher — in Asia, ICH affects 30 percent of all stroke victims. The finding “offers new hope for targeted therapy for this frequent cause of neurologic disability and death,” said Devin Brown and Lewis Morgenstern in an editorial in this week’s edition of The New England Journal of Medicine, where the study appears. Both Brown and Morgenstern are at the University of Michigan Health System. According to results of the study, which involved 73 medical centers in 20 countries, more than two-thirds of the 96 patients who got a placebo died or ended up severely disabled. Yet the rate ranged from 49 to 55 percent among the 303 who got one of three varying doses of the drug. The death rate after three months was 18 percent for the stroke patients who were given the hemophilia drug, and 29 percent among those who were not. Unfortunately, a drug that encourages clotting also carries a risk of a heart attack or another type of stroke, where blood flowing through the brain is blocked.The Mayer team found that while 2 percent of the patients given a placebo developed a serious heart attack or blocked blood vessel in the brain, the rate was 7 percent among those treated with the hemophilia drug. However, the researchers characterized that risk as “small.” The Mayer team also found that the timing of the treatment seemed important. “The best results were seen when patients were treated within three hours after the onset of symptoms,” the researchers said. That suggests that once the damage is done, brain bleeding rapidly diminishes over time, they said.(Source: Reuters Health. February 2005)