Rapid treatment cuts chances of stroke
Publication Date:10/10/2007
Getting treatment quickly after a ‘mini-stroke’ can dramatically cut the chances of having a full stroke, a new study shows. Almost 10,000 strokes could be avoided every year in the UK if everyone was seen at a walk-in clinic within a day of reporting symptoms, the researchers say.
What do we know already?
The medical name for a mini-stroke is transient ischaemic attack. It’s similar to a stroke, but the effects don’t last. Like a stroke, it happens when a blood clot blocks a vessel in your brain, stopping the blood getting through. If you have a mini-stroke, the blockage is only temporary. If you have a full stroke, the blockage lasts long enough to starve part of the brain of oxygen, causing brain damage. That’s why people who’ve had a stroke may have problems speaking or walking. The effects of a full stroke depend on which part of the brain is starved of oxygen.
Because a mini-stroke doesn’t usually cause long-term damage, it’s sometimes not treated seriously. But 1 in 10 people who have a mini-stroke go on to have a full stroke within the next week. Having a mini-stroke is one of the biggest risks for having a full stroke, which can cause disability and death. Treatments for a mini-stroke, including high dose aspirin and other drugs to make blood less likely to clot, can help prevent a full stroke.
Some people who have a mini-stroke don’t see a doctor or have any treatment. And for those who do, treatment varies around the country. Recommendations for doctors say patients who’ve had a mini-stroke should be seen by a specialist clinic. But many hospitals only hold these clinics on one day a week. About half of patients in the UK wait more than 14 days to be seen. Doctors worry that this may be too long, because patients may have a full stroke before they are started on treatment.
What does the new study/report say?
Doctors looked to see what would happen if people who had a mini-stroke were seen in a ‘walk-in’ specialist clinic and started on treatment within one or two days of reporting mini-stroke symptoms. They found that the numbers of people who went on to have a full stroke within 3 months fell dramatically, from 10 in 100 to just 2 in 100.
Tell me more about the study’s findings
This was a big study that followed up 1,278 patients who reported symptoms of a stroke or mini-stroke. It looked particularly at patients who were diagnosed with a mini-stroke (485 in total). The doctors looked at where they were treated, how quickly, what type of treatment they had and what happened to them in the 90 days after their mini-stroke.
The study was carried out in two phases. In the first phase, from 2002 to 2004, the doctors asked local GPs to refer any patients with mini-stroke symptoms to a daily stroke clinic. The clinic gave them appointments for tests, including brain scans, as soon as possible. The patients’ GPs were then sent the results of the tests, with suggested treatments for each patient. The patients were told to see their GPs quickly so they could be started on treatment. Patients in this part of the study were seen on average 3 days after reporting symptoms, and started treatment 20 days after reporting symptoms.
In the second phase, from 2004 to 2007, the doctors changed to a daily walk-in clinic. GPs were told to send patients with stroke symptoms directly to the clinic, on the same day, without arranging an appointment. The clinic did the necessary tests, then started the patients on their recommended treatment straight away, rather than sending results and suggested treatments back to the GPs. Patients in this part of the study were seen within a day of reporting symptoms, and also started treatment within a day.
The mini-stroke patients seen and treated quickly in the walk-in clinic were much less likely to have a stroke in the 90 days (3 months) after their mini-stroke than those who had to wait for an appointment. Only 2 in 100 mini-stroke patients seen and treated quickly had a full stroke in that time, compared to 10 in 100 patients who were given appointments and treated later by their GP. Most of the strokes happened in the first 10 days after the patients reported mini-stroke symptoms.
The doctors also checked to see if there were any bad effects from being treated quickly. Taking drugs to prevent blood clots means you may be more likely to get bleeding that is hard to stop. For most people who have a stroke or a mini-stroke, the benefits of avoiding another stroke outweigh the risks. But the doctors wanted to be sure the risk wasn’t bigger for people being treated quickly. They found people were no more likely to need treatment for bleeding if they were treated quickly.
Where does the study/report come from?
The research was carried out by doctors at the Radcliffe Infirmary in Oxford. It was published online by The Lancet medical journal, which is owned by a publishing company called Elsevier.
How reliable are the findings?
The findings are very reliable. The study covered everyone who reported mini-stroke or stroke symptoms within the Oxford area, over a 5 year period. The researchers took care to ensure they were tested and treated in the same way. The only difference was how soon they were seen and received treatment. Because the results showed a big difference in the likelihood of having a stroke between the two groups of patients, it is unlikely that the results were simply down to chance.
However, there were some differences between patients in the first and second phases of the study. Patients seen between 2004 and 2007 were slightly more likely to already be taking cholesterol-lowering drugs called statins. This could have had some effect on the results. But it is very unlikely that it could have accounted for so much difference between the groups.
The findings are reliable enough for the NHS to consider seriously, when health service managers are thinking about how best to plan services.
What does this mean for me?
If you, or someone you know, has symptoms of a stroke or a mini-stroke, don’t delay. It’s important to get medical help as soon as you can. Call your GP or go to an accident and emergency department. The sooner you are seen and start treatment, the less likely you are to have a full stroke.
These are symptoms that may mean you are having a stroke or mini-stroke. You may find that you suddenly:
- Feel weak on one side of your body.
- Can't feel anything on one side of your body. One side may feel numb.
- Have trouble speaking or understanding what is being said.
- Can't see out of one or both eyes. You may have gaps in what you can see or you may see double.
- Feel dizzy and unsteady, and have trouble walking.
- Have problems swallowing.
- Have a terrible headache. Many people describe these headaches as the worst headaches they've ever had.
Symptoms of a mini-stroke are the same as those of a full stroke, but they usually go away completely after a few hours. You should still get treatment quickly. If you don’t, you have a 1 in 10 chance of having a full stroke within a week.
Anyone can have a stroke, but you are more at risk if you are a man, older than 50, have high blood pressure, heart disease and if you smoke. Being overweight and drinking too much alcohol also increases your risk.
What should I do now?
Know the symptoms of a mini-stroke, and what to do if they happen. Many people who have a mini-stroke don’t think it’s serious. But you should treat mini-stroke symptoms as an emergency and get medical help straight away. Remember, the sooner you have treatment, the better your chances of avoiding a major stroke.
If you are concerned about your risk of having a stroke, you could see your doctor for a routine appointment. Your doctor can take your blood pressure and give you advice about how best to reduce your risk.
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© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
