Express Trial: New Guidelines for Stroke Treatment Needed

Kathleen Blanchard's picture

According to the results of a new study, aggressive medical treatment decreases cost and prevents disability, even for minor stroke and TIA (mini-stroke). Analysis from the Early Use of Existing Preventive Strategies for Stroke (EXPRESS) trial found the risk of having a second stroke could be reduced by 80% in patients who receive rapid, aggressive intervention for TIA and minor stroke. The study reveals the need for new guidelines for stroke treatment from policy makers.

According to Peter M. Rothwell, FMedSci, from John Radcliffe Hospital, in Oxford, the United Kingdom, "In contrast to most medical treatments or interventions, which cost money but do some good, this intervention would actually save much more money than it costs to implement." The study authors say the risk for having a second stroke within 7 to 10 days is 8 to 10 percent following a first stroke or TIA.

The analysis was conducted to provide healthcare policymakers with guidelines for stroke treatment that can cut healthcare cost,prevent disability, and prevent recurring stroke. The study is published in the March issue of Lancet Neurology. In an accompanying editorial, Naeem Dean, MD, and Ashfaq Schuaib, MD both from the University of Alberta, in Edmonton say …"most will agree that we now have sufficient evidence to treat patients with TIA on an urgent basis and that the time has come to translate this research into practice."


The study results may pose challenges. Educating healthcare employees, and setting up services to deliver urgent care to patients with minor stroke takes time and money.

However, the study authors say, "The care of patients with stroke and the prevention of further events in patients who present with TIA will, unfortunately, always be suboptimum as long as we fail to equate TIA and stroke care in line with the way we manage patients with acute coronary disorders."

Aggressive stroke treatment would save 290,000 hospital bed days, prevent about 10,000 strokes annually, and save millions in healthcare spending. "In addition, the reductions in disability rates at 6 months might lead to a reduction in the long-term usage of the health service in the community," say the authors.

The researchers concluded that stoke is an"underrecognized and poorly treated but common condition." They hope the study will bring awareness and implementation of new guildelines for aggressive stroke treatment from healthcare policy makers.

Lancet Neurol. Published online February 5, 2009.