Late Breaking Clinical Trials
In patients with stroke of unknown symptom onset and an MRI scan suggesting limited established damage, clot-busting intravenous thrombolysis resulted in a better functional outcome than placebo and similar to patients treated within the current 4.5-hour treatment window.
A clopidogrel-aspirin combination soon after minor stroke or TIA reduced the risk of ischaemic stroke, myocardial infarction and ischaemic vascular death (15 in 1000), at the cost of a smaller increase in the risk of major haemorrhage (5 in 1000), compared to aspirin.
Treatment with rivaroxaban in patients with embolic strokes of unknown source showed no reduction in recurrent stroke compared with aspirin, but major bleeding was increased.
The presence of cerebral microbleeds on an MRI predicts an increased risk of symptomatic intracranial haemorrhage in patients anticoagulated for atrial fibrillation after recent ischaemic stroke or transient ischaemic attack, but the absolute risk of haemorrhage was still lower than the risk of recurrent ischaemic stroke
**To be credited as 'Reprinted from The Lancet Neurology, https://dx.doi.org/10.1016/S1474-4422(18)30145-5, Wilson et al, Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study, Copyright (2018), with permission from Elsevier'
The 5-year risk of major cardiovascular events after a TIA or a minor ischemic stroke remains high at 12.9%, with a recurrent stroke rate of 9.5%, demonstrating that there is significant potential for reductions in recurrent stroke through novel treatments.
EXTRAS evaluated the clinical and cost-effectiveness of an Extended Stroke Rehabilitation Service provided for 18 months (n=285 patients, n=103 carers) compared with a control group (288 patients and 91 carers). Extended Stroke Rehabilitation Service did not improve stroke survivors’ participation in extended activities of daily living, nor did it lead to improved patient mood. However, differences were seen in favour of the intervention in terms of satisfaction with services
In the first Phase 2 study of treatment of acute stroke with novel anticoagulants, there was no significant increase in the risk of symptomatic haemorrhage, suggesting this novel treatment approach should be tested in larger, randomised controlled trials.
The Action Plan is a collaborative initiative to define the priorities for stroke care and research across Europe over the next decade, and provide guidance for European and national plans encompassing the chain of care from primary prevention to rehabilitation and life after stroke. It has been written by ESO in association with the patient organisation Stroke Alliance For Europe (SAFE), with input from the World Health Organization’s Regional Office for Europe.
Tranexamic acid treatment reduced the number of deaths, bleeding in the brain and serious complications in the early days following intracerebral haemorrhage, but there was no difference in the number of people who were left disabled or had died at three months after their stroke.
**To be credited as 'Reprinted from The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31033-X/fulltext, Sprigg et al, Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial, Copyright (2018), with permission from Elsevier'
The largest ever multicentre collaborative study in more than 520000 individuals identified 22 novel genetic factors associated with stroke, bringing the total of known genetic associations up to 32, identifying potential new mechanisms underlying stroke and future treatment targets. This study was recently published in Nature Genetics and a link to the paper: https://www.nature.com/articles/s41588-018-0058-3
A multinational study demonstrates wide variability in provision of stroke unit care in low and middle income countries, and the association between the availability of stroke units and clinical outcomes.
**Reprinted from The Lancet, https://doi.org/10.1016/S0140-6736(18)30802-X, Langhorne et al, Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study, Copyright (2018), with permission from Elsevier'
A Phase II study demonstrated that intentionally increasing blood pressure in acute stroke in patients not eligible for recanalization treatment may improve functional outcomes, warranting large scale Phase 3 trials.
This study assessed the effect of a dedicated multi-factorial organisational intervention to improve stroke services in Queensland, Australia.