Drug Trio May Cut Stroke Severity

Too Soon to Recommend the Drug Mix, Researchers Caution

From the WebMD Archives

April 24, 2006 -- Strokes caused by blood clots may be less severe in patients taking three particular types of drugs.

Those drug types -- antiplatelets, statins, and ACE inhibitors -- are already used to help prevent stroke in at-risk patients. Now, a new study shows that strokes tend to be less severe in patients taking all three drug types.

Doctors from Harvard Medical School and Boston's Beth Israel Deaconess Hospital worked on the study, which appears in Neurology.

"Our findings, although intriguing, are preliminary," write Sandeep Kumar, MD, and colleagues. However, they note that further studies are needed before recommending the drug trio for all patients at risk for stroke.

Stroke Study

Stroke is the No. 3 cause of death and a major cause of disability among U.S. adults. Every year, about 700,000 people in the U.S. have a stroke. That's one stroke every 45 seconds, on average, according to the American Stroke Association.

The most common type of stroke is ischemic stroke, in which blood flow to the brain is blocked. Those blockages may be due to a stationary clot that forms in a blood vessel or by a clot that travels through the bloodstream and becomes lodged in a blood vessel.

Kumar and colleagues studied 210 patients treated at the same hospital for ischemic stroke. All of the patients had arrived at the hospital within 24 hours of the start of stroke symptoms.

Prompt treatment for stroke is a must, since some clot-busting stroke drugs must be given within a few hours of the start of stroke symptoms.

Patients' Drugs

Here is an overview of the three types of drugs noted in the study:

  • Antiplatelets prevent the formation of blood clots. Aspirin is the most common antiplatelet drug.
  • Statins lower LDL "bad" cholesterol. They also have other effects, such as clot blocking.
  • ACE inhibitors widen (dilate) blood vessels and increase blood flow.

Before their stroke, 110 patients (52%) were taking an antiplatelet. That group included 47 patients who were only taking an antiplatelet, 29 taking an ACE inhibitor and an antiplatelet, 14 taking an antiplatelet and a statin, and 20 taking all three types of drugs.

Aspirin was the most common type of antiplatelet taken by the patients. Roughly all groups were examined at the hospital within six hours of the start of stroke symptoms, the study shows.


Less Severe Strokes

The study was done in hindsight. The researchers checked the patients' medical records to gauge stroke severity upon reaching the hospital.

Stroke severity on admission was significantly lower in patients taking all three types of drugs than in patients taking none of those drugs, antiplatelets alone, antiplatelets and statins, or antiplatelets and ACE inhibitors.

Average hospital stays were shorter with triple therapy (six days) than for patients only taking antiplatelets (seven days) or none of the drugs (nine days). The volume of brain tissue at risk after stroke was smaller in patients on triple therapy, the study also shows.

The degree of stroke recovery in hospital was similar among the groups. The key difference was the initial stroke severity, the researchers note.

Study's Limits

Larger, longer studies are needed before any recommendations are made, the researchers note. Here are three reasons for their caution:

  • The study doesn't show how the patients fared after leaving the hospital.
  • The researchers weren't able to adjust for any other illnesses patients may have had.
  • Patients weren't randomly assigned to take any (or none) of the drug types.

An editorial in the journal agrees.

The study is an "important" addition to the "growing evidence that statins and ACE inhibitors may be useful as neuroprotective agents in the setting of acute ischemic stroke," but more studies are required, the editorial notes.

The editorialists included Tanya Turan, MD, an assistant professor of neurology at Emory University.

WebMD Health News Reviewed by Ann Edmundson, MD, PhD on April 24, 2006


SOURCES: Kumar, S. Neurology, April 25, 2006; vol 66: pp 1153-1153. American Stroke Association: "Impact of Stroke." WebMD Medical Reference: "Understanding Stroke - the Basics." WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Heart Disease: Antiplatelet Drugs." WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "High Cholesterol: Cholesterol-Lowering Medication." WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Heart Disease: Heart Disease Medicine: ACE Inhibitors." Turan, T. Neurology, April 25; vol 66: p 1135. News release, American Academy of Neurology.

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