Studies tout treating mini-strokes fast

By MARIA CHENG, AP Medical WriterMon Oct 8, 7:00 PM ET
Treating patients quickly for mini-strokes could dramatically cut the risk of a major stroke later, report two studies that could change standard treatment and potentially save millions of people from stroke's damaging effects.
In research published Tuesday, British and French doctors found that patients treated within 24 hours of having a mini-stroke cut their chances by 80 percent of having a more serious stroke in the next three months.
Such large reductions in risk are rare, said Dr. Peter Rothwell of Oxford University, lead author of a study published in The Lancet medical journal. "We normally get excited about 10 to 15 percent."
Rothwell said that minor strokes should now be classified as medical emergencies. "The health care system needs to be changed to respond to these people quickly," he said. "The current delays in treatment in the United Kingdom are no longer acceptable."
In the U.K., most patients who have small strokes are referred by their doctors to specialist clinics. Many wait several weeks before being treated.
In the United States too, many people are sent home within a day if their symptoms seem to resolve.
Worldwide, nearly 15 million people have a stroke every year, and it is one of the leading killers in the industrialized world.
Mini-strokes, or transient ischemic strokes, have the same symptoms as a big stroke, including facial numbness, slurred speech, paralysis on one side of the body, blurry vision or a sudden headache. But in small strokes, the symptoms last less than a day.
Rothwell's research was drawn from a larger population of nearly 100,000 people being studied for vascular disease. Of 1,278 patients who had a stroke or a mini-stroke, he and colleagues examined roughly 600 people who had mini-strokes.
In the first part of the study, 310 mini-stroke patients were observed as they received standard care, under British medical guidelines. They were referred to an outpatient clinic. After a normal wait of about three weeks, these patients were typically prescribed drugs, including aspirin, to lower their blood pressure and cholesterol, and to prevent clotting.
In the second part of the study, about 281 other patients were given these same medications within 24 hours of their suspected mini-stroke.
The researchers found that the patients treated immediately had only about a 2 percent chance of having a major stroke in the next three months. In comparison, patients who weren't treated as quickly had about a 10 percent chance of having a major stroke in the next three months.
And among those who got delayed treatment, 32 had a bigger stroke. Among those in the group that got fast treatment, only six had a more serious stroke.
The study was funded by Oxford University. Rothwell has occasionally consulted for pharmaceutical companies that make drugs used in stroke prevention.
Similar research was published in Lancet Neurology. Dr. Pierre Amarenco of Bichat-Claude Bernard University Hospital in Paris and colleagues set up a 24-hour clinic to treat patients with suspected mini-strokes.
Among the 1,085 patients followed, the chance that patients would have another stroke within 90 days was a little over 1 percent. That compares to a predicted stroke rate of nearly 6 percent, based on historical medical data.
The Paris study was funded by a French non-profit organization. The authors said they had no conflicts of interest.
Doctors increasingly say that small strokes should be seen as warning signals for a more dangerous stroke later on, in the same way that chest pain can be a red flag for an imminent heart attack.
"We need to think of transient ischemic strokes as the 'angina' or 'acute coronary syndrome' equivalent for the brain," said Dr. Ralph L. Sacco, chairman of neurology at the University of Miami, who was not connected to the study. Sacco said that patients who have mini-strokes are at high risk of a more serious stroke and should be monitored more carefully.
The British Stroke Association said that Rothwell's study should lead to faster treatment of mini-strokes.
"We clearly should not be evaluating stroke symptoms in a leisurely sort of way," said Dr. Larry Goldstein, director of Duke University's Center for Cerebrovascular Disease, who was not connected to the studies. "The main message from these studies is that treatment delays can be dangerous."