Study points to challenges, hopes of helping vulnerable patients avoid stroke

May 10, 2016, University of Texas at Austin
Micrograph showing cortical pseudolaminar necrosis, a finding seen in strokes on medical imaging and at autopsy. H&E-LFB stain. Credit: Nephron/Wikipedia

A new study published in the New England Journal of Medicine today demonstrates both the importance and the challenge of treating people who are at high risk of a stroke.

In the study, led by Dr. Clay Johnston, a neurologist and specialist who serves as dean of the Dell Medical School at The University of Texas at Austin, a team of researchers studied the effects of the drug ticagrelor on people who have suffered a minor ischemic stroke or what is known as a , or TIA.

The study, which looked at more than 13,000 in 33 countries, did not find that ticagrelor was better than aspirin, the current standard, in reducing the risk of stroke, heart attack, or death in patients presenting with TIA or minor stroke. About 6.8 percent of patients in the study who were taking ticagrelor suffered a stroke, heart attack or death within 90 days of the initial attack, versus about 7.5 percent of patients who were taking aspirin. It also demonstrated that ticagrelor is about as safe as aspirin even though it works in the body in a completely different way. The European biopharmaceutical company AstraZeneca sponsored the study.

"There are still too many strokes afflicting patients with TIA and minor stroke, whether they are taking ticagrelor or aspirin," Johnston said. "While this study doesn't necessarily show that we can prevent strokes among this group any better with this one drug, it does open the possibility that combinations of drugs could reduce the risks that these vulnerable patients face."

Minor strokes account for about a third of total strokes, and TIAs are about as frequent - about 250,000 TIAs and about 200,000 minor strokes are diagnosed each year in the United States. Both involve a blockage in a blood vessel, leading to stroke symptoms that either resolve or become permanent. Without treatment, roughly 10 percent of patients who experience TIA or suffer a stroke just weeks or months after the initial attack, Johnston said.

Johnston is scheduled to discuss the study at the European Stroke Organisation Conference 2016 this week in Barcelona, Spain.

Stroke prevention and treatment is a growing focus of the Seton-Dell Medical School Stroke Institute, a collaboration with the Seton Healthcare Family meant to transform care in Central Texas and catalyze research on treating and preventing stroke.

Seton is working with Dell Medical School to provide specialized stroke in-patient units at the new Dell Seton Medical Center at The University of Texas, which opens in 2017.

"Getting evaluated by a stroke subspecialist here in our community will get a patient the most appropriate treatment more quickly - and it will lead to better outcomes for stroke patients," said Dr. Steve Warach, director of the Stroke Institute, who also is slated to address the conference in Barcelona. "We also want to develop therapies for stroke situations that now don't have any therapies. Working with other U.S. researchers, we must discover and develop ways to effectively treat of all kinds across the region."

Explore further: Simple two-drug combination proves effective in reducing risk of stroke

More information: S. Claiborne Johnston et al, Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack, New England Journal of Medicine (2016). DOI: 10.1056/NEJMoa1603060

Related Stories

Simple two-drug combination proves effective in reducing risk of stroke

June 26, 2013
Results of a Phase III clinical trial showed that a simple drug regimen of two anti-clotting drugs – clopidogrel and aspirin – lowered the risk of stroke by almost one-third, compared to the standard therapy of aspirin ...

Adding clopidogrel to aspirin therapy reduces risk of second stroke

February 11, 2013
Adding a second drug to aspirin therapy reduced the risk of a second stroke in the weeks after Chinese patients had a minor ischemic (due to a clot) stroke or a transient ischemic attack (TIA), according to research presented ...

Preadmission SSRI use ups stroke mortality in diabetes

May 9, 2016
(HealthDay)—For patients with diabetes, preadmission selective serotonin reuptake inhibitor (SSRI) use is associated with increased risk of stroke mortality, according to a study published online May 3 in the Journal of ...

Resistance to aspirin tied to more severe strokes

February 23, 2015
People who exhibit a resistance to aspirin may be more likely to have more severe strokes than people who still respond to the drug, according to a study released today that will be presented at the American Academy of Neurology's ...

Migraine with aura linked to clot-caused strokes

February 17, 2016
People who have migraines with aura are more likely to have strokes caused by either a blood clot in the heart (cardio-embolic stroke) or a clot within the brain's blood vessels (thrombotic stroke), compared to those that ...

Five fast things you should know about stroke

April 29, 2016
You don't need superpowers to be a hero when it comes to stroke, you just need to pay attention to the risk factors and know the warning signs.

Recommended for you

Surgery involving ultrasound energy found to treat high blood pressure

May 23, 2018
An operation that targets the nerves connected to the kidney has been found to significantly reduce blood pressure in patients with hypertension, according to the results of a clinical trial led in the UK by Queen Mary University ...

New guidelines mean 1 in 3 adults may need blood pressure meds

May 23, 2018
(HealthDay)—One out of every three U.S. adults has high blood pressure that should be treated with medication, under guidelines recently adopted by the two leading heart health associations.

To have or not to have... your left atrial appendage closed

May 22, 2018
Each year in the U.S., more than 300,000 people have heart surgery. To reduce risk of stroke for their patients, surgeons often will close the left atrial appendage, which is a small sac in the left side of the heart where ...

Natural antioxidant bilirubin may improve cardiovascular health

May 18, 2018
Bilirubin, a yellow-orange pigment, is formed after the breakdown of red blood cells and is eliminated by the liver. It's not only a sign of a bruise, it may provide cardiovascular benefits, according to a large-scale epidemiology ...

New algorithm more accurately predicts life expectancy after heart failure

May 17, 2018
A new algorithm developed by UCLA researchers more accurately predicts which people will survive heart failure, and for how long, whether or not they receive a heart transplant. The algorithm would allow doctors to make more ...

New genes found that determine how the heart responds to exercise

May 17, 2018
A new study by researchers at Queen Mary University of London and University College London (UCL) has discovered 30 new gene locations that determine how the heart responds to and recovers from exercise.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.