Stroke Units, Tissue Plasminogen Activator, Aspirin and Neuroprotection: Which Stroke Intervention Could Provide the Greatest Community Benefit?

Vol. 20, No. 4, 2005

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Original Paper

Stroke Units, Tissue Plasminogen Activator, Aspirin and Neuroprotection: Which Stroke Intervention Could Provide the Greatest Community Benefit?
Amanda K. Gilligan^{a-d, f}, Amanda G. Thrift^{a-c, e}, Jonathan W. Sturm^{b, g,h}, Helen M. Dewey^a-c, Richard A.L. Macdonell^a-c, Geoffrey A. Donnan^a-c

^aDepartment of Neurology, Austin and Repatriation Medical Center,
^bNational Stroke Research Institute, Heidelberg; Departments of
^cMedicine, University of Melbourne,
^dMedicine and
^eEpidemiology and Preventive Medicine, Monash University, Melbourne;
^fEastern Melbourne Neurosciences, Box Hill Hospital, Box Hill; Departments of
^gNeurology, Central Coast Area Health, Sydney, and
^hMedicine, University of Newcastle, Newcastle, Australia

Address of Corresponding Author

Cerebrovasc Dis 2005;20:239-244 (DOI: 10.1159/000087705)

Key Words

Stroke, acute
Tissue plasminogen activator
Community-based stroke units

Abstract

Background: Although a number of acute stroke interventions are of proven efficacy, there is uncertainty about their community benefits. We aimed to assess this within a defined population. Methods: Eligibility for tissue plasminogen activator (tPA), aspirin, stroke unit management and neuroprotection were assessed among incident stroke cases within the community-based North East Melbourne Stroke Incidence Study. Results: Among 306,631 people, there were 645 incident strokes managed in hospital. When eligible patients were extrapolated to the Australian population, for every 1,000 cases, 46 (95% CI 17-69) could have been saved from death or dependency with stroke unit management, 6 (95% CI 1-11) by using aspirin, 11 (95% CI 5-17) or 10 (95% CI 3-16) by using tPA at 3 and 6 h, respectively. Conclusions: Although tPA is the most potent intervention, management in stroke units has the greatest population benefit and should be a priority.

Author Contacts

Prof. G.A. Donnan
National Stroke Research Institute
300 Waterdale Road
Heidelberg West, Vic. 3081 (Australia)
Tel. +61 613 9496 2699, Fax +61 613 9496 2650, E-Mail gdonnan@unimelb.edu.au

Article Information

Received: January 12, 2005
Accepted: May 19, 2005
Published online: August 22, 2005
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 3, Number of References : 27

Medline Abstract (ID 16123543)

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