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NIHR Signal Two antiplatelet drugs may prevent further strokes but increase major bleeds
People experiencing a minor stroke or a transient ischaemic attack have a lower risk of further stroke within 90 days if given clopidogrel and aspirin, rather than aspirin alone. However, taking both drugs doubles the risk of bleeding over the same period. Current UK guidelines recommend using clopidogrel alone. In this major international trial of nearly 5,000 people, those who took the dual treatment had fewer heart attacks or strokes than those who took aspirin only, particularly in the fir...
NIHR Signal Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke
A combination of aspirin, clopidogrel and dipyridamole does not reduce the incidence or severity of recurrent stroke in people who have had a stroke or transient ischaemic attack (TIA). This NIHR-funded trial compared the triple treatment to current guideline-based antiplatelet therapy for preventing further stroke or TIA (brief loss of blood supply to the brain). UK guidance recommends aspirin initially followed by clopidogrel alone as for most people this gives the best balance of effectivene...
NIHR Signal Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation
In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin. This study pooled the data in all trials reporting efficacy, safety and cost of anticoagulant prevention of stroke events in people with...
NIHR Signal Giving oxygen routinely after a stroke does not improve outcomes
There was no benefit to routinely giving oxygen to people who have had a stroke. Oxygen given continuously, or just overnight, did not reduce disability or death and it did not improve people’s ability to do everyday tasks or live independently. There were no oxygen-related adverse events reported. Strokes occur when the blood supply to the brain is disrupted by either a blocked or burst blood vessel. They can lead to death or disability as parts of the brain are deprived of blood. Theref...
NIHR Signal Second-hand smoke levels in Scottish prisons equivalent to living with a smoker
Staff in Scottish prisons inhale roughly the same amount of second-hand smoke at work as they would in the average smoking household (32μg of fine particulate matter per m3). Some activities, like inspecting a smoky prison cell, exposed staff to far higher levels (up to 753.6μg per m3). Despite smoking bans in public spaces across the UK, around three-quarters of prisoners smoke. This poses health threats from second-hand smoke to staff and prisoners alike. This NIHR study detailed the s...
NIHR Signal Head position after acute stroke does not affect disability outcomes
Lying flat for 24 hours after a stroke is no better than sitting up at an angle of at least 30 degrees. These differences in early head position did not affect people’s levels of disability or survival to 90 days, which was more than 92% in both groups. It had been thought that the head down position might increase the chance of pneumonia, but in this trial, the rates were also similar for people cared for in either position. The results of this large international randomised controlled t...
NIHR Signal Group rehabilitation activities improve walking after stroke
Group-based circuit class therapy (CCT) focused on repetitive mobility, and functional tasks improved walking ability in people after stroke. People walked on average 61m further during six minutes than those receiving comparison interventions. CCT involves stroke survivors practising different activities at workstations in sight of each other. This Cochrane review identified 17 trials of group-based CCT, given at least weekly for four weeks, compared with other physical therapies or no interve...
NIHR Signal Carers of stroke survivors voice an unmet need for practical and emotional support
The carers of stroke survivors express a need to be recognised by hospital rehabilitation teams as partners in care. Carers emphasised that their deep knowledge can contribute to joint decision making about the care of their spouse or family member. This research suggests that considering carers’ needs for support, information and training into care planning could ease the distress currently reported. This review describes how family, friends and spouses often felt emotionally overwhelmed...
NIHR Signal Mechanical clot removal for stroke reduces disability at two years
Timely mechanical removal of the blood clots from inside vessels in the brain after a stroke reduces disability and improves quality of life at two years compared with usual care. Over a third of those in the thrombectomy group had good functional outcome compared with less than a quarter of the standard care group who received clot busting drugs. This was similar to the results at 90 days and was associated with improved quality of life in terms of self-care and mobility. Findings came from a ...
NIHR Signal Intensive speech therapy helps stroke survivors with persistent communication difficulties
Intensive speech and language therapy begun six months or more after a stroke improved verbal communication, language comprehension and self-reported quality of life for those with persistent communication difficulties (chronic aphasia). The therapy in this trial consisted of around 30 hours over three weeks. Participants who received low-intensity therapy (around one hour per week) whilst on a waiting list did not improve during that time. NICE guidelines recommend speech and language therapy ...
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