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Cerebrovascular Disease and Ischemia

開催日 2014/9/13
時間 11:00 - 12:00
会場 Poster / Exhibition(Event Hall B)

Reduction of Cerebral Hemorrhage by Dabigatran via Neurovascular Protection after Recanalization with tPA in Ischemic Stroke of Rat

  • P3-331
  • 河野 祥一郎 / Syoichiro Kono:1 出口 健太郎 / Kentaro Deguchi:1 山下 徹 / Toru Yamashita:1 菱川 望 / Nozomi Hishikawa:1 阿部 康二 / Koji Abe:1 
  • 1:岡山大学神経内科 / Department of Neurology, Okayama University 

Background & Objectives
This study aimed to assess the risk and benefit of tPA treatment under oral anticoagulation with dabigatran compared to warfarin or vehicle control in transient middle cerebral artery occlusion (tMCAO).

After pretreatment with warfarin (0.2 mg/kg/day), dabigatran (20 mg/kg/day), or vehicle (0.5% carboxymethyl cellulose sodium salt) for 7 days, tMCAO was induced for 120 min followed by reperfusion and tPA (10 mg/kg/10 ml). Clinical parameters, including cerebral infarction volume, hemorrhagic volume, and blood coagulation, were examined. At 24 h after reperfusion, markers for the neurovascular unit at the periischemic lesion were immunohistochemically examined in brain sections, and MMP-9 activity was measured by zymography.

Paraparesis and intracerebral hemorrhage volume were significantly improved in the dabigatran-pretreated group than in the warfarin-pretreated group. A marked dissociation between astrocyte foot processes and the basal lamina or pericyte was observed in the warfarin-pretreated group, which was greatly improved in the dabigatran-pretreated group. Furthermore, a remarkable activation of MMP-9 in the ipsilateral warfarin-pretreated rat brain was greatly reduced in dabigatran-pretreated rats.

The present study reveals that the mechanism of intracerebral hemorrhage with warfarin-pretreatment plus tPA in ischemic stroke rats is the dissociation of the neurovascular unit, including the pericyte. Neurovascular protection by dabigatran, which was first shown in this study, could partly explain the reduction in hemorrhagic complication by dabigatran reported in the clinical study.

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