The Possible Role of Cerebrolysin in Prevention of Hemorrhagic Transformation after Acute Ischemic Stroke

Hemorrhagic transformation (HT) is one of the most feared challenges in management of acute ischemic stroke (AIS) that affects both the treatment plan and the clinical prognosis.  The risk for HT is not monocausal and it is almost impossible to define a single target for prevention of HT. Thus, we consider that it is worthwhile to investigate and review the possible role of Cerebrolysin as a multimodal, pleiotropic neuroprotective and neurotrophic agent in the prevention of HT. Cerebrolysin has been the subject of multiple animal and in vitro studies, the majority of which have yielded encouraging results in terms of pleiotropic and multimodal neuroprotective and neurorestorative activity. Cerebrolysin has been investigated in multiple clinical trials. Over the past 10 years, among the studies investigating the effect of Cerebrolysin in acute ischemic stroke, 5 studies have reported the extent of hemorrhagic transformation as a part of the outcome. Lower HT rates were reported for Cerebrolysin treated patients versus controls across all studies. Thus, the reported results are consistent across all studies, however, the differences did not reach the level of statistical significance except for one study. The interpretation of these results is limited by several considerations. Despite these limitations, in the light of the clearly positive clinical results of Cerebrolysin on functional recovery and its favorable safety profile, a dose of 30 ml/day for 10-21 days may be given to reduce the risk of HT. This observation should be confirmed by further large randomized controlled clinical trials with standardization of the HT definition.