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The Apparent Paradox of Acute Stroke Prevention


January 18, 2016

Most elderly patients who underwent treatment for acute stroke could have avoided the life-threatening emergency if they were on the right preventative medications, according to new findings.

Investigators studied 274 patients who averaged 67 years of age and were treated and discharged for ischemic stroke at the University of California Irvine Medical Center between December 2010 and June 2012. A 10-point scale was used to measure the extent of stroke preventability, with a score of 0 representing no possibility of prevention, scores of 1 to 3 equating to low preventability, and scores of 4 or higher indicating the stroke was highly preventable.

Stroke was at least somewhat preventable in three-fourths of the patients and highly preventable in 25% of the patients, according to the findings, which showed the average preventability score was 2.2. Notably, the National Institutes of Health Stroke Scale (NIHSS) was 9.0 among all the patients, regardless of where they rated on the researcher’s scale.

According to the study, 53 patients received intravenous or intra-arterial therapies for stroke prevention. The researchers noted that administration of acute therapy was unrelated to the NIHSS score, but significantly related to the study’s preventability score: 19% of patients with no preventability, 14% of patients with low preventability, and 30% of patients with high preventability were administered the acute therapy.

The study’s results pointed to an apparent paradox, according to Dr. Mark Fisher, the study’s lead author and a professor of neurology at the University of California Irvine School of Medicine. “The recent breakthroughs in acute stroke therapy have led to massive efforts to streamline the evaluation of acute stroke patients and institute therapy as fast as feasible,” he commented. “These efforts will lead to more effective mitigation of brain injury consequent to acute ischemic stroke.

“However, our data suggested that the difficulties faced by acute stroke patients extend far beyond the rather narrow period of emergency stroke treatment,” continued Dr. Fisher. “If one takes what could be characterized as a more holistic approach to the problem of stroke, there’s a vast expansion of the window of intervention to include the very stroke prevention efforts that appear to be lacking in so many hyper-acute stroke patients.”

Stroke preventability and stroke treatability are closely associated, noted Dr. Fisher, who added, “These findings raise the question of whether resources for acute stroke treatment are being directed toward those patients whose strokes are, in fact, the most preventable.”

Stroke prevention is a lifelong effort and pharmacists are in a unique position to encourage medication usage over the long haul, according to Dr. Fisher. He said compliance of stroke prevention medications is typically measured at hospital discharge.

“How can that compliance be monitored over the course of years, not months?” he asked. “Pharmacists may be able to make a major contribution there.”

The study was published online in JAMA Neurology. It received no industry support.

 

—Dan Cook

 

Reference:

1. Fisher M, Moores L, Alsharif MN, Paganini-Hill A. Definition and implications of the preventable stroke. JAMA Neurol. 2015 Dec 7. [Epub ahead of print]

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