Stroke drugs can boost quality of life

Posted 20/06/2013

Patients given a clot-busting drug within six hours of a stroke are more likely to have a good quality of life 18 months afterwards, an international study suggests. 

The Stroke Association has said that the research is “encouraging”. However, the review of more than 3,000 patients found the drug – alteplase – offered no improvement in survival rates. The drug is increasingly being used in specialist stroke units in the UK.

The treatment is given to patients who have had an ischaemic stroke, when the brain’s blood supply is interrupted by a clot. A stroke can cause permanent damage such as paralysis and speech problems and can be fatal. Without treatment, a third of people who suffer a stroke die, with another third left permanently dependent and disabled.

The trial, led by researchers at the University of Edinburgh, followed patients from 12 different countries, half had the alteplase treatment, which is given intravenously, and half did not. The researchers suggested that for every 1,000 patients given the drug within six hours of stroke, by 18 months, 36 would be able to manage independently and will have less pain and discomfort than if they had not had it. However, that is the average and more of those given alteplase within the first hour or two after a stroke will see such benefits.

The down side is that the drug does carry a risk of causing a potentially fatal bleed in the brain in the first week after treatment for around three in 100 patients. The experts behind the study say patients and their families have to weigh up the risks as well as the potential benefits.

Professor Sandercock, who led the study, said that what doctors need to say is that “this is a difficult decision for patients and their families. They have to say this is a treatment that carries risks.” He said someone who had experienced a major stroke which would affect their ability to live and work as they had previously, may wish to take the drug, despite the bleed risk, whereas a patient who had a more minor stroke which did not affect them so badly may not. It is a personal choice, comparing immediate risk versus long-term benefits.

Professor Sandercock added: “In the UK in 2002, the estimated annual cost of long-term care of an independent survivor of stroke and a dependent survivor were £876 against £11,292 respectively, so even a small difference in the proportion of survivors who are able to look after themselves will have a substantial economic impact.”

Dr Clare Walton of the Stroke Association, said: “There are over 150,000 strokes in the UK each year, and around 85% of these are caused by a clot in the brain. If these patients can get to hospital within 4½ hours, some are eligible for clot-busting treatments which can greatly reduce brain damage and disability after the stroke.” She said it was “encouraging” to see that the positive effects of treatment were maintained over the longer term. Dr Walton added that when a stroke strikes, time lost is brain lost. The sooner patients receive treatment the more likely they are to make a better recovery.

Julie Crossley, a medical injury lawyer at Ashtons Legal, comments: “This is encouraging news but obviously this is not treatment without major risk. It may be that someone who is relatively well and independent who suffers a major stroke would rather take the risk of having a fatal bleed than become long-term dependent. This is obviously a personal choice. But it must be something that the doctors can discuss with the patient and family before administering any type of drugs”.