Review of stroke treatment could save lives

Doctors are underutilising crucial medication to prevent deadly strokes in those with a common type of heart condition, new research says, leading to fresh calls for a review of current treatment strategies and more research into stroke prevention.

Stroke is Australia’s second biggest killer after coronary heart disease and is a major cause of disability. A new study of over 26,000 stroke patients, has found those with Atrial Fibrillation (AF) – an irregular heartbeat commonly seen in the elderly – have a mortality rate almost twice that of other stroke patients.

As many as 90 percent of patients with AF-related stroke do not receive appropriate blood-thinning medication at the time of their stroke. Researchers say a number of fatal and disabling strokes could therefore be prevented through the better use of existing anticoagulant medication.

The study, led by researchers from the University of New South Wales and the Ingham Institute, is published this month in the journal Cerebrovascular Diseases.

It found that patients with AF make up one in four of the most common form of stroke (ischaemic stroke). Patients with AF had twice the chance of dying in hospital and had a mortality rate of 40 per cent, one year after their stroke. Such patients also had much longer hospital stays and were more likely to be disabled.

“This is the biggest evidence practice gap in cardiovascular health,” lead report author, Ingham Institute researcher and UNSW conjoint Associate Professor, John Worthington, said.

He said doctors are underutilising anticoagulants because of an excessive concern over bleeding risk, despite “robust guidelines” being in place for treating AF patients who are over 65 years old. Anticoagulants ‘thin’ the blood to help prevent blood clots that cause ischaemic strokes. There is a small risk that patients on anticoagulants will suffer major bleeding, including the risk of a brain haemorrhage.

The paper also highlights the limitations of existing strategies to accurately predict and prevent stroke among younger AF patients, who account for 10 per cent of young strokes in the study as well as 19 per cent of early deaths. For many of these patients, “their first stroke will be their last,” Associate Professor Worthington said.

However, 20-30 per cent of young stroke patients with AF would have been judged as ‘low risk’ by current practices, and not given anticoagulants. The study calls for “urgent research”, with a focus on how to better determine stroke risk in all AF patients and for trials of new and existing anticoagulants in younger AF patients.

Other researchers on the study were Dr Melina Gattellari, Mr Chris Goumas and Mr Robert Aitken. The study was funded by the Federal Department of Health and Ageing and UNSW.