Another failed neuroprotective agent – ALIAS part 2

Today i give a little review about ALBUMIN 25% as a neuroprotective agent in case of ischemic stroke. Ginsberg et. all. published in the LANCET NEUROLOGY a placebo controlled double blinded phase 3 trial  where they looked for a favourable outcome for the use of ALBUMIN in the early treatment of stroke. ALIAS part 1 showed a trend to a favourable outcome. So about 800 patients were enrolled. Patients in the verum group received 25% ALBUMIN (2g per kg/KG). Favourable outcome was defined as NIH-SS of 0 and 1 or/and mRS of 0 and 1 at 90 days. About 85% in both groups received thrombolysis. The investigation was stopped due to futility in september 2012. There was no outcome differ after 841 patients enrolled. During the early phase of the trial there was promissing data in favour of ALB treatment.
Pulmonary oedema was more common as well as intracerebral hemorrhage in the ALB group.
I personally exspected a different result. In the light of SAFE-TBI there could have been even a different result showing harm if using ALB.
So standard fluid for resus a patient with ischemic insult remains cristalloid. But i think that you have an option for ALB in selected cases.

Notes:
SAFE-TBI, Cooper et all., J Neurotrauma. 2013 Apr 1;30(7):512-8. doi: 10.1089/neu.2012.2573. Epub 2013 Mar 21.
ALIAS part 1, Hill et all., Stroke. 2011 Jun;42(6):1621-5. doi: 10.1161/STROKEAHA.110.610980. Epub 2011 May 5.
ALIAS part 2, Ginsberg et all., Lancet Neurol. 2013 Sep 26. pii: S1474-4422(13)70223-0. doi: 10.1016/S1474-4422(13)70223-0. [Epub ahead of print]

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