Lowering blood pressure after a stroke that has been thrombolysed (broken down) reduces the risk of intracranial bleeding. This treatment has been debated so far.
A new study shows that the most common form of stroke worldwide have an improvement of the treatment. According to this unpublished data, stroke patients who experienced an intense drop in their blood pressure were significantly less likely to experience bleeding in the brain, a side effect associated with people taking thrombolysis * that breaks the blood clot.
Making treatment of thrombolysis safer
Professor Craig Anderson, executive director of the George Institute and the study, said: “There has been a lot of debate about whether certain benefits are outweighed by the potential harms of an intensive drop in blood pressure soon after the onset of an acute stroke. ” He adds: “This study clearly shows that more intensive control of blood pressure than what is currently recommended can make the treatment of thrombolysis safer, reducing the risk of severe bleeding in the brain .”
The study involved more than 2,000 patients, recruited from 110 hospitals in 15 different countries between 2013 and 2018. “These results also highlight the need for further research in order to better understand the mechanisms underlying the benefits and the disadvantages of an early and intensive drop in blood pressure in patients receiving treatment with thrombolysis, since the reduction in cerebral hemorrhage has not resulted in improved overall recovery for patients “, a added Professor Tom Robinson, co-author and director of the Cardiovascular Research Center at the University of Leicester.
Sudden loss of function in part of the brain
A stroke, also known as a “stroke”, is a sudden loss of function in part of the brain, caused by a sudden cessation of blood flow inside an artery . The severity of the stroke will depend on the location and extent of the affected brain areas. Each area of the brain is specialized (motor skills, speech, vision, etc.). A localized accident will therefore suppress a function in part, or in whole, which explains why a person can keep physical after-effects of a stroke (paralysis of part of the body or face, reduction or disappearance of vision, problems of speech …).
According to the World Health Organization (WHO), nearly 5 million people worldwide die from stroke each year and 15 million are victims of non-fatal stroke. In France, it is estimated that between 120,000 and 130,000 people are affected each year. But thanks to more efficient devices, mortality linked to strokes has dropped by 15% in recent years in France.
Stroke: this treatment reduces the risk of relapse
Double antiplatelet therapy, which combines aspirin and clopidogrel, reduces the risk of relapse of cardiovascular accidents in people who have had a minor stroke or TIA, a transient ischemic attack.
Having a minor stroke or TIA puts patients at a high risk of relapsing cardiovascular events, which can go as far as devastating strokes. Currently, these patients are receiving antiplatelet therapy with just aspirin. However, several clinical trials have shown that combining aspirin with clopidogrel, an antiplatelet agent, could reduce the risk of relapse.
Reduced risk of relapse
In order to examine whether or not double treatment effectively reduces the risk of having a new cardiovascular accident for people who have suffered a first minor stroke or a TIA, the researchers analyzed the results of three previous studies involving a total of 10,447 patients. Their results were published in the journal BMJ .
The results show that the double antiplatelet treatment, implemented within 24 hours of the first mini stroke or TIA, reduces the risk of relapse of a new stroke by approximately 2%. In addition, the analysis of the conclusions of these three studies shows that relapses occur mainly in the days following the first stroke. However, it is exactly during this period that the double treatment is most effective compared to the isolated intake of aspirin. The study also reveals that the beneficiaries of dual antiplatelet therapy benefit from a better quality of life.
Relative side effects
Despite everything, the study shows that double antiplatelet treatment is likely to slightly increase the risk of moderate or major extra-cranial hemorrhage. However, with a risk of 0.2%, these events are much less frequent than the relapse of minor strokes or TIAs.
Minor hemorrhages also increase with the taking of a double treatment, but the effect is quite low since the risk is increased by 0.7%, a result much less important than the risks of recurrence of a new stroke.
“Dual antiplatelet therapy with clopidogrel and aspirin given within 24 hours of a TIA or stroke reduces the risk of subsequent stroke by about 2%, with few serious adverse consequences,” say the researchers. .
If the reduction in stroke rates is seen from the first day of treatment in patients who have taken aspirin and clopidogrel, it will decrease after 10 days of treatment. After 21 days of treatment, the beneficial effects of reducing the risk of relapse balance between monotherapy or dual antiplatelet therapy, reducing the risk of relapse becoming almost similar. “Stopping double antiplatelet therapy from the 10th day, and at the latest 21 days after the start of treatment, is likely to maximize its net benefits”, conclude the researchers.