Treatment of urgent stroke: changing guidelines? Interesting study in The Lancet
Results from an Australian-led international clinical trial, published in The Lancet, address intense debate around the best urgent stroke treatment
It confirms that bridging therapy (intravenous thrombolysis combined with endovascular thrombectomy), produces better patient outcomes than endovascular thrombectomy alone, and is safe.
Urgent Stroke: why was the DIRECT-SAFE study undertaken?
For people experiencing an acute stroke, standard treatment involves the use of intravenous thrombolysis (to dissolve the clot) and endovascular thrombectomy (to remove the clot).
However, as joint lead author of the study Professor Peter Mitchell explains, there has been “increasing unease in giving patients intravenous thrombolytics due to fears of increasing haemorrhage and clot migration”.
In order to address these concerns, DIRECT-SAFE (an international clinical trial involving acute-care hospitals across Australia, New Zealand, China and Vietnam) was designed to investigate whether “bridging therapy” (intravenous thrombolysis combined with thrombectomy) or thrombectomy alone delivered optimal outcomes for stroke patients.
About Urgent Stroke Treatment: what were the results of the DIRECT-SAFE study?
The trial looked at both the safety aspects and the effectiveness of the two treatment approaches.
The results showed that bridging therapy produced better outcomes than thrombectomy alone, as measured by functional independence at 90 days, post stroke.
Importantly, the safety outcomes were also shown to be similar between the two groups.
Discussing the results, joint lead author, Professor Bernard Yan, says the study “showed that bridging treatment was better, especially in Asian region patients. Patients in the bridging treatment arm had better outcomes across the entire study”.
Why are the findings of DIRECT-SAFE important?
DIRECT-SAFE has provided critical information on the optimal approach for the acute treatment of stroke, which has been a topic of intense debate in recent years.