Pharmacological management of cerebral ischemia in the elderly

ABSTRACT

Introduction: For elderly adults in the United States, stroke is the fifth leading cause of death of which ischemic strokes comprise a vast majority. Optimal pharmacological management of elderly ischemic stroke patients involves both reperfusion and supportive care. Recent research into pharmacological management has focused on vascular, immunomodulatory, cytoprotective, and alternative agents, some of which have shown limited success in clinical trials. However, no treatments have been established as a reliable mode for management of cerebral ischemia for elderly adults beyond acute thrombolysis.

Areas covered: The authors conducted a literature search for ischemic stroke management in the elderly and a search for human drug studies for managing ischemic stroke on clinicaltrials.gov. Here, they describe recent progress in the pharmacological management of cerebral ischemia in the elderly.

Expert opinion: Many drug classes (antihypertensive, cytoprotective and immunomodulatory, and alternative agents) have been explored with limited success in managing ischemic stroke, though some have shown preventative benefits. We generally observed a broad gap in evidence on elderly patients from studies across all drug classes, necessitating further studies to gain an understanding of effective management of ischemic stroke in this large demographic of patients.

KEYWORDS:

• Antihypertensive
• antiplatelet
• cytoprotective
• elderly
• immunomodulatory
• ischemia
• management
• pharmacology
• stroke
• thrombolytic

Article highlights

• In elderly adults in the United States, stroke is the fifth leading cause of death of which ischemic strokes comprise a vast majority

• Optimal pharmacological management of elderly ischemic stroke patients involves both reperfusion and supportive care.

• Recent research into pharmacological management has focused on vascular, immunomodulatory, cytoprotective, and alternative agents, some of which have shown limited success in clinical trials though no treatments have become established as reliable modes for the management of cerebral ischemia for elderly adults beyond acute thrombolysis.

• Specifically, there is a notable gap in evidence from prospective randomized clinical trials on the effective treatment of acute ischemic stroke (AIS) in elderly populations, despite the fact that almost a third of stroke patients are over the age of 80

• If trials are to have any impact on the treatment of AIS in the elderly, they should aim to enroll a greater proportion of elderly patients.

• Ultimately, gaining a better understanding of AIS in the elderly as well as gathering generalizable, clinically-relevant data will be integral to improving treatments for AIS in the elderly.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.