Ancrod, a purified venom extract from the Malaysian pit viper, induces rapid defibrinogenation, which, in turn, may increase local thrombolysis by stimulating plasminogen activators. In 1994, a study was undertaken in the United States and Germany to test the safety and efficacy of this treatment in ischemic stroke patients who present within 6 hr. A nonsignificant improvement in outcome was noted at 3 months, with no symptomatic hemorrhages in the ancrod group (31). The Stroke Treatment with Ancrod trial studied ancrod in acute stroke using a 3-hr window (32). Using the primary efficacy endpoint of Barthel Index > 95 at 90 days revealed a statistically significant difference in outcome between ancrod and placebo groups (42.2% vs. 34.4%; p = 0.01). This effect was proportional to the rate of defibrinogenation. A nonsignificant trend toward increased symptomatic hemorrhages in the ancrod group was also reported.
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