Our objective was to determine whether continuous transcranial Doppler (TCD) monitoring could safely enhance the efficacy of
batroxobin, a
thrombin-like
enzyme extracted from Bothrops atrox moojeni
venom, in the treatment for acute
cerebral stroke beyond the thrombolytic time window. Ninety patients suffering an acute
cerebral stroke were recruited into the study within 12 hours after the onset of symptoms. Patients were randomized to receive
batroxobin with (target group) or without 1 hour of continuous TCD monitoring (control group). Clinical evaluation of
stroke was based on the National Institutes of Health
Stroke Scale (NIHSS) score, Barthel index (BI), Thrombolysis in
Brain Ischemia score (TIBI), the incidence of advancing
stroke, and the recurrence of
cerebral infarction. The patients receiving continuous TCD monitoring showed significant improvement in NIHSS score at 57 days post treatment compared with the control. Similarly, patients receiving continuous TCD monitoring also showed significant improvement in BI at 3 months compared with the controls. Consistently, both the incidence of advancing
stroke after 1 week and the incidence of
stroke recurrence after 3 months were significantly lower in TCD monitored group than control group. Moreover, the safety of the employment of TCD monitoring in the treatment of these patients was confirmed as there was no significant difference of the incidence of
intracranial hemorrhage at 1 week after the treatment between the target and control groups. Taken together, our study showed that
batroxobin, in combination with continuous TCD monitoring at the middle cerebral artery, reduced the incidence of advancing
stroke and
stroke recurrence
after treatment without adverse effects in terms of poststroke
intracranial hemorrhage.