Hemodilution

Mechanical thrombectomy in stroke is a useful additional option to thrombolysis. However, as the authors themselves wrote, only 4–10% of all stroke patients benefit from this intervention (1) Unfortunately, on average only 12% of patients with cerebral infraction receive thrombolysis treatment; in Berlin, the proportion is 14%, but in rural areas it is notably lower.

The guideline for the diagnostic evaluation and therapy in neurology with the AWMF [Association of the Scientific Medical Societies in Germany] registration number 030/46 expressly does not recommend hemodilution treatment. For the most part, this is based on a review by Asplund, which was published in 2002, which included 18 studies of hemodilution (2). Dextran-40, hydroxyethyl starch (HAES), or albumin were used for the purpose of dilution, which was done hypervolemically or isovolemically. Mortality did not reduce significantly in the initial four weeks and six months. Tendentially positive clinical effects were observed for HAES and albumin.

Only a maximum of 20% of stroke patients—about 50 000 patients per year—benefit from thrombolysis or thrombectomy. For this reason, hypervolemic hemodilution with HAES or albumin should not be ruled out as a matter of principle, but should be regarded as an option especially in older patients who are not able take in sufficient fluids orally. Hemodilution leads to a clear improvement in microcirculation, even in the brain (3).

Further studies investigating the effectiveness of hemodilution are needed.