A randomized controlled trial of hemodilution therapy in acute ischemic stroke.

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Abstract
Rapid hemodilution in the early phase of ischemic stroke by the combination of venesection (250-650 ml during the first 2 days) and administration of low-MW dextran was evaluated in a prospective controlled trial. Fifty-two patients were randomized to hemodilution therapy and 50 to a control group; the 2 groups were comparable in important prognostic variables. Mean Hb was reduced from 147 to 127 g/l, hematocrit from 43 to 37% and, in a subsample of patients, whole-blood viscosity at a shear rate of 23 s-1 from 7.0 to 4.3 cps over the first 2 days. Hemodilution was then maintained by repeated dextran infusions. Of the hemodiluted patients, 85% improved in neurological scoring over the first 10 days as compared to 64% of the control patients (P < 0.025). The case fatality rate during the first 3 mo. was little affeced by hemodilution. Among the survivors, 8% of the hemodiluted and 31% of the non-hemodiluted patients were unable to work at 3 mo. The proportion of surviving patients still hospitalized at the 3-mo. follow-up was 13% in the hemodiluton group and 39% in the control group (P < 0.01). The combination of venesection and dextran 40% administration is thus an unsophisticated but effective way to achieve rapid hemodilution in patients with acute cerebral infarction, and it improves the overall clinical outcome over the first 3 mo.