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Studies suggest prompt treatment for mini-strokes

Treating patients quickly for transient ischemic strokes could cut the risk of a major stroke later on, according to studies published in the Lancet

Treating patients quickly for transient ischemic strokes (TIAs/ mini-strokes) could cut the risk of a major stroke later on, according to studies published in the Lancet.

Doctors in the UK and France discovered that patients treated within 24 hours of having a TIA had their chances of suffering a more serious stroke in the following three months by 80 per cent.

Around 15 million people have a stroke each year, with the condition becoming one of the leading causes of death in the industrialised world.

Most patients in the UK who present with small strokes are referred by their doctors to specialist clinics. Many wait several weeks before being treated.

Dr Peter Rothwell of Oxford University, lead author of the UK study, said that such large reductions in risk are rare and that doctors normally get excited by risk reductions of about 10 to 15 per cent.

Rothwell warned that minor strokes should now be classified as medical emergencies and that the healthcare system should change to respond to these people quickly.

The current delays in treatment in the UK were no longer acceptable, declared Rothwell, who has consulted for pharmaceutical companies manufacturing drugs used in stroke prevention.

TIAs have the same symptoms as a big stroke, including facial numbness, slurred speech, bilateral paralysis, blurred vision or sudden headache. In small strokes, the symptoms last less than a day, however.

Rothwell's research, which was sponsored by the University of Oxford, was taken from a larger population of nearly 100,000 being studied for vascular disease. Of 1,278 patients presenting with stroke or a TIA, the research team examined approximately 600 people who had had TIAs.

In the first arm of the study, 310 TIA patients were observed as they received standard care, under current British medical guidelines. They were then referred to an outpatient clinic. After a normal wait of about three weeks, patients were typically prescribed drugs, including aspirin, to lower their blood pressure and cholesterol and prevent thrombosis.

In the second arm, approximately 281 other patients were given these same medications within 24 hours of their suspected mini-stroke.

Researchers discovered that the immediately treated patients had only about a two per cent chance of having a major stroke in the next three months. Conversely, patients who were not treated as quickly had a 10 percent chance of having a major stroke over the same time period. Among those who got delayed treatment, 32 had a bigger stroke, while for those in the fast-treated group only six suffered a more serious stroke.

The British Stroke Association said that Rothwell's study should lead to faster treatment of mini-strokes.

The second study, published separately in The Lancet Neurology by French researcher Pierre Amarenco and colleagues, also found that early aggressive treatment brought similar results in cutting the chance of a major stroke. 

The results of the studies will be good news for manufacturers of antihypertensives, statins, anti-thrombotics, all of which are prescribed to prevent or combat the effects of stroke.

According to a 2006 Datamonitor report, the R&D landscape in the setting of acute stroke is not dominated by any one company. It is, in fact, shaped by the need to minimise the commercial risk associated with developing drugs for the acute-care stroke market, which is characterised by high unmet market and clinical needs.

The current UK guidelines for treating stroke can be accessed here

30th September 2008

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