Review of stroke treatment could save lives

Doctors are underutilising crucial medication to prevent deadly strokes in those with a common type of heart condition, new research says, leading to fresh calls for a review of current treatment strategies and more research into stroke prevention.

Stroke is Australia's second biggest killer after coronary heart disease and is a major cause of disability. A new study of over 26,000 stroke patients, has found those with Atrial Fibrillation (AF) – an irregular heartbeat commonly seen in the elderly – have a mortality rate almost twice that of other stroke patients.

As many as 90 percent of patients with AF-related stroke do not receive appropriate blood-thinning medication at the time of their stroke. Researchers say a number of fatal and disabling strokes could therefore be prevented through the better use of existing anticoagulant medication.

The study, led by researchers from the University of New South Wales and the Ingham Institute, is published this month in the journal Cerebrovascular Diseases.

It found that patients with AF make up one in four of the most common form of stroke (ischaemic stroke). Patients with AF had twice the chance of dying in hospital and had a mortality rate of 40 per cent, one year after their stroke. Such patients also had much longer hospital stays and were more likely to be disabled. "This is the biggest evidence practice gap in cardiovascular health," lead report author and UNSW conjoint Associate Professor, John Worthington, said.

Assessing the Risk of a First Stroke

It is helpful for healthcare providers and the public to be able to estimate a person’s risk for a first stroke. As detailed in the sections that follow, numerous factors can contribute to a person’s stroke risk, and many individuals have >1 risk factor. Some of these risk factors are relatively less well documented, and specific or proven treatments may be lacking. Although most risk factors have an independent effect, there may be important interactions between individual factors that need to be considered in predicting overall risk or choosing an appropriate risk modification program. Risk-assessment tools have been used in community stroke screening programs and utilized in some guideline statements to select certain treatments for primary stroke prevention. Some of the goals of such risk-assessment tools are (1) to identify persons at elevated risk who might be unaware of their risk; (2) to assess risk in the presence of >1 condition; (3) to measure an individual’s risk that can be tracked and lowered by appropriate modifications; (4) to estimate a quantitative risk for selecting treatments or stratification in clinical trials; and (5) to guide appropriate use of further diagnostic testing.

He said doctors are underutilising anticoagulants because of an excessive concern over bleeding risk, despite "robust guidelines" being in place for treating AF patients who are over 65 years old. Anticoagulants 'thin' the blood to help prevent blood clots that cause ischaemic strokes. There is a small risk that patients on anticoagulants will suffer major bleeding, including the risk of a brain haemorrhage.