Nav: Home

Drug to treat bleeding may benefit some stroke patients, study finds

May 16, 2018

Patients with stroke caused by bleeding on the brain (intracerebral haemorrhage) may benefit from receiving a drug currently used to treat blood loss from major trauma and bleeding after childbirth, an international trial has revealed.

The study, led by experts at The University of Nottingham and funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme, found that giving tranexamic acid (TXA) to people who had experienced intracerebral haemorrhage reduced the number of deaths in the early days following the stroke.

It also found that both the amount of bleeding in the brain and number of associated serious complications were lower in the patients who had received the TXA treatment.

However, the trial found no difference in the number of people who were left disabled or had died at three months after their stroke (the study's primary outcome). The researchers believe further study is needed on larger groups of patients to enable them to fully understand the potential benefits.

The research is published in the medical journal The Lancet and was presented at the 4th European Stroke Conference in Gothenburg, Sweden on 16th May.

Nikola Sprigg, Professor of Stroke Medicine at the Stroke Trials Unit in the University's Division of Clinical Neuroscience, led the trial. She said: "Tranexamic acid is cheap - costing less than £15 per patient - and widely available so has the potential for reducing death and disability across the world."

"While we failed to show significant benefits three months after stroke, the reduction in early deaths, amount of bleeding on the brain and serious complications are signs that this drug may be of benefit in the future. More trials are needed, particularly focusing on giving treatment as soon as possible after the start of bleeding in this emergency condition.

"TICH-2 cements the position of the NIHR and the UK as key players in the world of stroke research. A study of this scale would simply not have been possible without support of the NIHR infrastructure. Alongside the large stroke centres, the contribution made by the network of smaller sites across the UK has been crucial to the success of TICH-2."

Around 150,000 people in the UK suffer a stroke every year -- the majority of these are ischaemic strokes caused by a blocked blood vessel on the brain which can be treated very successfully in many cases with the use of clot-busting drugs (thrombolysis) administered within 4.5 hours of the stroke.

However, 15 per cent of all strokes -- affecting around 22,000 people every year -- are caused by haemorrhagic stroke when a blood vessel in the brain bursts, leading to permanent damage. While all people with acute stroke benefit from treatment on a stroke unit, there is currently no specific treatment for haemorrhagic stroke and unfortunately many people affected will die within a few days. Those who do survive are often left with debilitating disabilities including paralysis and an inability to speak.

A previous small pilot study by The University of Nottingham and funded by both the university and the charity the Stroke Association, concluded that a larger study was needed to accurately assess the effectiveness of the drug tranexamic acid. The drug was chosen for the study after previous research showed that it was successful in stopping bleeding in people involved in road traffic accidents.

For the latest trial, people who were diagnosed as having had bleeding on the brain -- confirmed by CT scan -- were offered the chance to take part in the study. Where the person was too ill to decide, permission was asked of their family or close friends. Where no family were available a doctor unconnected with the study decided if the patient should take part.

The five-year TICH-2 trial recruited more than 2,000 patients from 124 hospitals in 12 countries between 2013 and 2017. They were randomly sorted into two patient groups - one received TXA within eight hours of their stroke and another was given a saline placebo. In the UK, more than 80 hospitals took part in the study with support from the NIHR clinical research network.

CT scans of the patients' brains were performed 24 hours after their stroke and their progress was monitored and measured at day two and day seven after their stroke. The final follow up was performed at 90 days.

The study revealed that TXA did not improve the outcome for patients after 90 days as there was no significant difference in the number of patients who had subsequently died or had been left with disabilities between the TXA and placebo groups at three months.

However, in the TXA group there were fewer deaths by day seven following the stroke and, at day two, fewer people on TXA experienced a worsening of the bleed on their brain and had smaller amounts of blood in the brain compared to their control group counterparts. Also, the number of patients who experienced associated serious complications (such as pneumonia and brain swelling) were lower in the patients who had received the TXA treatment compared to those who had control.

The trial also found evidence that TXA might be more effective in patients with lower blood pressure as those with blood pressure lower than 170 mmHg had a more favourable outcome that those with 170mmHg and above. Other studies have confirmed that the sooner TXA is given, the more effective it is, and ideally it needs to be given within less than 3 hours of bleeding onset. In this study only one third of patients were given treatment within 3 hours of stroke onset.

As a result, the researchers have highlighted the need for further studies to find out whether giving an earlier dose of TXA might be beneficial for patients.
-end-


University of Nottingham

Related Stroke Articles:

Retraining the brain to see after stroke
A new study out today in Neurology, provides the first evidence that rigorous visual training restores rudimentary sight in patients who went partially blind after suffering a stroke, while patients who did not train continued to get progressively worse.
Catheter ablations reduce risks of stroke in heart patients with stroke history, study finds
Atrial fibrillation patients with a prior history of stroke who undergo catheter ablation to treat the abnormal heart rhythm lower their long-term risk of a recurrent stroke by 50 percent, according to new research from the Intermountain Medical Center Heart Institute.
Imaging stroke risk in 4-D
A new MRI technique developed at Northwestern University detects blood flow velocity to identify who is most at risk for stroke, so they can be treated accordingly.
Biomarkers may help better predict who will have a stroke
People with high levels of four biomarkers in the blood may be more likely to develop a stroke than people with low levels of the biomarkers, according to a study published in the Aug.
Pre-stroke risk factors influence long-term future stroke, dementia risk
If you had heart disease risk factors, such as high blood pressure, before your first stoke, your risk of suffering subsequent strokes and dementia long after your initial stroke may be higher.
Intervention methods of stroke need to focus on prevention for blacks to reduce stroke mortality
Blacks are four times more likely than their white counterparts to die from stroke at age 45.
Study shows area undamaged by stroke remains so, regardless of time stroke is left untreated
A study led by Achala Vagal, M.D., associate professor at the University of Cincinnati College of Medicine and a UC Health radiologist, looked at a group of untreated acute stroke patients and found that there was no evidence of time dependence on damage outcomes for the penumbra, or tissue that is at risk of progressing to dead tissue but is still salvageable if blood flow is returned in a stroke, but rather an association with collateral flow -- or rerouting of blood through clear vessels.
Immediate aspirin after mini-stroke substantially reduces risk of major stroke
Using aspirin urgently could substantially reduce the risk of major strokes in patients who have minor 'warning' events.
SAGE launches the European Stroke Journal with the European Stroke Organisation
SAGE, a world leading independent and academic publisher, is delighted to announce the launch of the European Stroke Journal, the flagship journal of the European Stroke Organisation.
The S-stroke or I-stroke?
The year 2016 is an Olympic year. Developments in high-performance swimwear for swimming continue to advance, along with other areas of scientific research.

Related Stroke Reading:

My Stroke of Insight: A Brain Scientist's Personal Journey
by Jill Bolte Taylor (Author)

The astonishing New York Times bestseller that chronicles how a brain scientist's own stroke led to enlightenment

On December 10, 1996, Jill Bolte Taylor, a thirty-seven- year-old Harvard-trained brain scientist experienced a massive stroke in the left hemisphere of her brain. As she observed her mind deteriorate to the point that she could not walk, talk, read, write, or recall any of her life-all within four hours-Taylor alternated between the euphoria of the intuitive and kinesthetic right brain, in which she felt a sense of complete well-being and peace, and the... View Details


Stronger After Stroke, Third Edition: Your Roadmap to Recovery
by Peter G Levine (Author)

Now in its third edition, Stronger After Stroke puts the power of recovery in the reader's hands by providing simple-to-follow instructions for reaching the highest possible level of recovery. The book’s neuroplastic recovery model stresses repetition of task-specific practice, proper scheduling of practice, setting goals, and measuring progress to achieve optimal results. Researcher Peter G. Levine breaks down the science and gives survivors evidence-based tools to retrain the brain and take charge of recovery.

In easy-to-read sections, Stronger After... View Details


Healing the Broken Brain: Leading Experts Answer 100 Questions about Stroke Recovery
by Dr. Mike Dow (Author), David Dow (Author), Megan Sutton CCC-SLP (Contributor)

If you’re holding this book, it likely means you or someone you love has had a stroke. Dealing with the onslaught of information about stroke can be confusing and overwhelming. And if you happen to be a stroke survivor with newly impaired language skills, it can be especially hard to comprehend everything your doctors, nurses, and specialists are telling you.

This book consists of the top 100 questions that survivors and their families ask, with answers from the top physicians and therapists in the country. The questions start out basic but then get more specific to address... View Details


Stronger After Stroke: Your Roadmap to Recovery, 2nd Edition
by Peter G. Levine (Author)

Stronger After Stroke puts the power of recovery in the reader's hands by providing simple-to-follow instructions for reaching the highest possible level of recovery. Basic concepts covered include repetition of task-specific practice, proper scheduling of practice, setting goals and measuring recovery.

Sections new to the second edition cover the latest research from neuroscience, treatments for recovering sensation as well as recovery strategies for the young stroke survivor. Also included is a breakdown of the phases of recovery and how these phases can provide structure... View Details


Stroke: Pathophysiology, Diagnosis, and Management, 6e
by James C. Grotta MD (Author), Gregory W Albers MD (Author), Joseph P Broderick MD (Author), Scott E Kasner MD MSCE FRCP (Author), Eng H. Lo PhD (Author), A David Mendelow MB BCh FRCS PhD (Author), Ralph L Sacco MD MS FAHA FAAN (Author), Lawrence KS Wong MD FRCP (Author)

Offered in print, online, and downloadable formats, this updated edition of Stroke: Pathophysiology, Diagnosis, and Management delivers convenient access to the latest research findings and management approaches for cerebrovascular disease. Picking up from where J. P. Mohr and colleagues left off, a new team of editors ― Drs. Grotta, Albers, Broderick, Kasner, Lo, Mendelow, Sacco, and Wong ― head the sixth edition of this classic text, which is authored by the world’s foremost stroke experts.

Comprehensive, expert clinical guidance... View Details


Puzzles for Stroke Patients
by Kalman Toth (Author)

BEST PUZZLE BOOK FOR STROKE REHAB! #1 Best Seller puzzle (14 challenging puzzle types with increasing difficulty) book for stroke patients to recover brain and memory functions. Customer: "Great gift for my mom!!!" Word, logic & math puzzles are recommended for patients by doctors, neurologists, speech & cognitive therapists to rebuild mental abilities in language, math & logic. Puzzles are essential for brain rehabilitation. Neurologist: “For stroke victims, I suggest word-guess puzzles because they can’t really do the New York Times Sunday magazine crossword puzzle.” Another... View Details


Living With Stroke: A Guide for Patients and Their Families
by Richard C. Senelick MD (Author)

The fifth edition of Living with Stroke updates this highly popular guide for patients and families. There are 800,000 strokes each year and this book provides survivors and families with the wide variety of information and resources in one location. It has received widespread praise from professionals and laymen for its clarity and readability. View Details


Stroke For Dummies
by John R. Marler (Author)

Features tons of advice for recovery and rehabilitation

Get the latest on the symptoms, diagnosis, and treatment of stroke

Have questions and concerns about strokes? This reassuring guide provides invaluable information for stroke victims and their loved ones, from what a stroke is and what it feels like to proven treatments and therapies. You'll see how to implement a plan for preventing stroke, treat the lingering effects of stroke, and maximize home caregiver effectiveness while minimizing fatigue.

Discover how to:

Understand what causes different... View Details


Stroke Certification Study Guide for Nurses: Q&A Review for Exam Success
by Kathy Morrison MSN RN CNRN SCRN (Author)

Now with a free mobile & web app with print purchase!

This sought-after companion to the author’s popular Fast Facts for Stroke Care Nursing is a must-have study guide for nurses seeking Stroke Certified Registered Nurse (SCRN®) status. It contains comprehensive information about the exam, answers to commonly asked questions, and savvy tips for maximizing your score, along with 300 practice questions and answers with rationales.

Designed to prepare nurses for the multiple-choice format of the certification exam, questions are arranged in chapters... View Details


STROKE: The Road to Recovery: A Guide for Survivors & Families
by Dr. F. Douglas Prillaman Ed.D. (Author), Mr. Tom Willett (Contributor), Dr. S. James Shafer M.D. (Contributor), Mrs. Eleanor W. Prillaman M.Ed. (Contributor)

If you, or someone you love, has had a stroke, you’ve probably already discovered that it’s extremely hard to get a simple, straightforward explanation of what happened and what you can do about it. Much of what you’ll hear from your doctors is cloaked in nearly incomprehensible medical jargon. This book, written by a stroke victim and his neurologist, explains the causes, diagnosis and treatment of stroke in plain language. You’ll learn about:

• Common Causes & Effects of Stroke • Getting Immediate Help • Rehabilitation Hospitals & Outpatient Care • Home Health Care... View Details

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Attention Please
In an age of constant information and infinite distractions, how can we pay more attention to our ... attention? This hour, TED speakers explore the battle for our awareness during the digital age. Guests include sociologist Zeynep Tufekci, podcast host Manoush Zomorodi, neuroscientist Amishi Jha, designer Tristan Harris, and computer scientist Jaron Lanier.
Now Playing: Science for the People

#475 Mother Nature is Trying to Kill You (Rebroadcast)
This week, we're learning how deadly and delightful our planet and its ecosystem can be. We're joined by biologist Dan Riskin, co-host of Discovery Canada's Daily Planet, to talk about his book "Mother Nature Is Trying to Kill You: a Lively Tour Through the Dark Side of the Natural World." And we'll talk to astronomer and author Phil Plait about Science Getaways, his company that offers educational vacation experiences for science lovers.