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Trial aims to help more people avoid a second stroke

UCLH and UCL researchers are to investigate the best time to give blood thinning medicines to patients who have had a stroke linked to a type of irregular heartbeat known as atrial fibrillation (AF) – in order to help more people avoid a second stroke.

AF is a heart rhythm disturbance which can lead to a clot forming inside the heart. This clot can travel to the brain, blocking its blood supply and causing a stroke.

Those who have suffered a stroke due to AF are at increased risk of having another stroke, which can be reduced by taking blood thinning medicines. But a rare but dangerous side effect of blood thinning medicines is bleeding into the brain – and there is a lack of evidence about when best to commence them after a stroke.

“Every day in the UK there are around 690 hospital visits due to a stroke."

Professor David Werring, Consultant Neurologist at UCLH, and his team have been awarded more than £2 million by the British Heart Foundation to lead a clinical trial to address this question.

More than 1.3 million people in the UK have been diagnosed with AF – and they are five times more likely to have a stroke than people without AF.

The OPTIMAS trial will compare the effects of starting the newest type of blood thinning medicine (called a DOAC) less than four days after stroke with the current practice of waiting seven to fourteen days.

Patients will be recruited from over 100 UK hospitals. Half will start blood-thinning medication earlier, and half will start them later. Information about their health and progress over 90 days after their stroke will be analysed to see which treatment time is most beneficial. 

Professor Werring said: “Every day in the UK there are around 690 hospital visits due to a stroke – we want to slash this number and reduce the risk of further complications by delivering safer and more effective treatments.

“These results could transform the way we treat patients with AF-related stroke and ensure they spend less time in hospital and more time at home with their families.”

Dr Shannon Amoils, Senior Research Advisor at the BHF, added: “Clinicians treating people with stroke after AF have to strike a delicate balance to deliver optimal care. Ideally they would like to restart anticoagulant drugs sooner rather than later to lower the risk of another AF-related stroke, but they must also consider the risk of bleeding. We’re delighted to be funding the OPTIMAS trial, which will provide stroke doctors with the evidence to make this important clinical decision."