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Hemorrhagic transformation of ischemic stroke in diabetics on sulfonylureas
Author(s) -
Kunte Hagen,
Busch Markus A.,
Trostdorf Katrin,
Vollnberg Bernd,
Harms Lutz,
Mehta Rupal I.,
Castellani Rudolf J.,
Mandava Pitchaiah,
Kent Thomas A.,
Simard J. Marc
Publication year - 2012
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.23680
Subject(s) - medicine , glibenclamide , stroke (engine) , diabetes mellitus , sulfonylurea , incidence (geometry) , complication , ischemia , cardiology , anesthesia , endocrinology , mechanical engineering , physics , optics , engineering
Objective: Disability or death occurs more frequently in patients with hemorrhagic transformation (HT) after ischemic stroke. In rat models of stroke, sulfonylurea (SU) drugs such as glibenclamide (adopted US name, glyburide) confer protection against swelling and HT through actions on the novel SUR1‐regulated NC Ca‐ATP channel. Here, we sought to determine whether the use of SU drugs in patients with diabetes mellitus (DM) presenting with acute ischemic stroke might influence the incidence of HT. Methods: We retrospectively analyzed data on 220 patients with DM who presented with acute ischemic stroke, 43 of whom were managed with and continued to receive SU drugs, and 177 of whom were managed without (controls). Results: During a median length of stay in hospital of 11 days, 20 control patients (11%) experienced symptomatic HT (sHT), whereas no patient in the SU group experienced sHT ( p = 0.016). No patient in the SU group died, compared to 18 (10%) in the control group ( p = 0.027). Similarly favorable outcomes were observed after matching for baseline imbalances and excluding outliers. In support of the proposed mechanism, we present a case of sHT in which an analysis of brain tissues obtained intraoperatively showed prominent upregulation of SUR1, the target of SU drugs, in microvessels and neurons. Interpretation: We conclude that, in diabetic patients with acute ischemic stroke, prior and continued use of SU drugs is associated with reduced sHT compared to those whose treatment regimen does not include SU drugs. ANN NEUROL 2012;72:799–806