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Medical experts have devised a new treatment protocol for a common form of stroke that is difficult to treat. Image credit: Santi Nuñez/Stocksy.
  • Researchers investigated the effects of a new stroke treatment plan focusing on reducing blood pressure within hours of symptom onset.
  • The new treatment plan reduced adverse outcomes compared to existing care.
  • The researchers hope their findings may be integrated into standard-of-care practices for stroke worldwide.

Intracerebral hemorrhage (ICH) happens when blood vessels bleed into brain tissue. It is the second most common cause of stroke, accounting for 15-30% of cases.

ICH is also the least treatable form of stroke and has the highest mortality rate. Between 40 and 50% of patients with the condition die within 30 days of onset.

ICH commonly occurs in low-income to middle-income countries that have a high rate of risk factors such as hypertension and unhealthy diets. Novel treatments for the condition could improve prognosis and potentially save thousands of lives.

Recently, researchers from The George Institute for Global Health conducted a randomized controlled trial for a new ICH treatment approach in in over 7,000 pateints from 10 countries, nine of which were low and middle-income countries.

The new treatment reduced the likelihood of poor outcomes, including death, after 6 months.

The study was published in The Lancet.

Dr. Sunil Sheth, director of the vascular neurology program with McGovern Medical School at UTHealth Houston, not involved in the study, told Medical News Today that, “[p]articularly for regions of the country or world where these types of practices are not standard, the findings give strong support for [the] implementation of these best practice measures.”

For the study, the researchers recruited 7,036 patients from 121 hospitals across nine low- and middle-income countries, including China, Nigeria, and Pakistan, and one high-income country (Chile). Patients had an average age of 62 years old, just over a third were women, and all were admitted to the hospital for imaging-confirmed ICH.

After admission, they received either the new treatment approach — known as the “Care Bundle” — or each country’s pre-existing standard of care.

The Care Bundle included:

  • reducing blood pressure to less than 140 millimeters of mercury (mmHg) within 1 hour of starting treatment
  • reducing elevated blood glucose levels as soon as possible
  • reducing body temperature to under 37.5 degrees Celsius within an hour of starting treatment
  • reversing abnormal anticoagulation in those taking blood thinners such as warfarin within an hour of treatment.

Clinicians aimed to maintain the specifics indicated by the Care Bundle for 7 days.

Ultimately, patients treated via the Care Bundle group were significantly less likely to experience a poor outcome — such as death — 6 months after treatment. Researchers estimated that, for every 35 patients treated, the approach prevented one additional death.

The researchers further noted that 16% of patients in the Care Bundle group experienced serious adverse side effects compared to 20.1% in the standard-of-care group.

MNT spoke with Dr. Adi Iyer, a neurosurgeon and interventional neuroradiology at the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA, not involved in the study, about the results.

“This treatment protocol includes the early lowering of blood pressure, controlling body temperature, blood sugars, and reversing blood thinners. We currently don’t have guidelines on how quickly this needs to be done and to what extent, exactly. This protocol, if implemented, widely will standardize exactly what needs to be done when a patient with a hemorrhagic stroke comes to the emergency room,” he noted.

MNT also spoke with Dr. Mona Bahouth, assistant professor of neurology at Johns Hopkins Medicine, not involved in the study, about the results. She noted that the researchers found in a subanalysis that most of the benefits of the Care Bundle came from reducing blood pressure.

“While this study will help to motivate other hospitals to standardize their post-stroke care, it does not change our practices in the United States. We have long known that standardized, stroke center care that tends to these types of physiological details could help patient outcomes,” she added.

The researchers wrote that their study faced some limitations. As many patients had severe illness and required urgent neurosurgery, obtaining early consent for treatment was, at times, challenging.

Dr. Bahouth added: “Very few patients enrolled in this study were taking blood thinners at the time of hospitalization for ICH. So it is difficult to make any references to the benefit of early reversal of blood thinners for patients taking blood thinners at the time of the hemorrhagic stroke.”

Dr. Sheth noted: “The study was performed primarily in low-income countries, as these populations were the focus of the investigators’ study question. Extrapolation to other regions may not be applicable.”

The researchers nevertheless conclude that the Care Bundle protocol improved functional outcomes for patients. They hope that hospitals around the world will use this approach in clinical practice to treat ICH.

When asked about a key takeaway from the study, Dr. Iyer said:

“The study [shows] that early, rapid standardized management of patients with hemorrhagic stroke can have significant long-term outcome benefits.”

Dr. Bahouth, nevertheless, pointed out that: “These results will not really change our practice in the United States as we have used goal-directed, specialized care in the stroke unit for many years. Globally, it will be supportive data for hospitals to review their protocols and standardize their approach to stroke care.”