This site gives a short overview of interesting results from other stroke-related research projects.
In a recently published international study leadingly conducted by Charité – Universitätsmedizin Berlin, the effect of structured aftercare after minor strokes and temporary circulatory disorders of the brain (so-called transitory ischemic attacks, TIA) was investigated. The researchers focused on the individual constellation of risk factors in the patients examined and accompanied those affected by regular appointments with experienced and specially trained nursing staff. The aim was to prevent a recurrence of stroke by changing lifestyle habits and regular intake of the prescribed medication.
Unfortunately, no direct effect on the occurrence of cardiovascular diseases could be achieved through the additional care of stroke patients within the follow-up period of about three and a half years. However, patients with more intensive and structured follow-up care showed a significant reduction in risk factors, which was reflected in better blood pressure values, lower cholesterol levels and more frequent successful smoking cessation. Therefore, a positive effect with regard to the occurrence of future cardiovascular diseases is very likely. It is highly probable that the study failed to show statistical evidence due to the comparatively short observation period under study conditions.
We are pleased that the topic of stroke aftercare is becoming increasingly important in current research and that innovative care concepts are being discussed and tested in clinical studies. The combined approach of personal contact and digital support envisaged in the PostStroke Manager project could be a decisive step in the further development of innovative care concepts and at the same time provide exciting new impetus.
Reference: Ahmadi M, Laumeier I, Ihl T, et al. A support programme for secondary prevention in patients with transient ischaemic attack and minor stroke (INSPiRE-TMS): an open-label, randomised controlled trial. Lancet Neurology 2020; 19: 49-60
2019/06/07 An integral part of the follow-up treatment of stroke patients is the secondary prophylactic medication. It is administered to prevent secondary strokes and is adjusted individually according to the patients risk profile. Patients with known atrial fibrillation will be treated according to guidelines with oral anticoagulants, meaning they will be given „blood-thinners“ in the form of tablets.
However, one group of patients is hard to categorize in this risk profile: Namely, patients with a diagnosis which points to an underlying heart condition or arrhythmia (atrial fibrillation), which however cannot be observed at the time of the stroke incident. This group is said to have an „embolic stroke of undetermined source“ (ESUS).
In two recently published studies (last of which was the RE-SPECT ESUS study, published last month) it was investigated to what extend ESUS-patients benefit from anticoagulation. More specifically the rate of secondary incidents was compared when the patient was given anticoagulants or the standard treatment, e.g. acetylsalicylic acid.
Unfortunately, no advantage could be found with the stronger „blood-thinners“. Hence, in future studies other diagnostic and treatment options have to be examined more closely. Furthermore the study shows how important follow-up treatment is for stroke patients, because a close post-incident supervision can help to identify additional risk-factors and to adjust the medication accordingly.
Reference: Diener HC, Sacco RL, Easton JD, Granger CB, Bernstein RA, Uchiyama S, Kreuzer J, Cronin L, Cotton D, Grauer C, Brueckmann M, Chernyatina M, Donnan G, Ferro JM, Grond M, Kallmünzer B, Krupinski J, Lee BC, Lemmens R, Masjuan J, Odinak M, Saver JL, Schellinger PD, Toni D, Toyoda K; RE-SPECT ESUS Steering Committee and Investigators. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N Engl J Med 2019; 380: 1906-1917.