STROKE RESEARCH

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STROKE RESEARCH

• at QEQMH and EKHT

Monday January 28th 2008
Joan Idris Clinical Trials Co-ordinator
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Stroke Research Network

• South-East one of 10 local networks
• Dedicated Staff
• Multiple Clinical Trials
• Part of UKCRN

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Clinical Trials
Current
In Set-Up

• PERFORM
• CLOTS
• DNA Lacunar

• IST3
• COSSACS
• TRACS

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PERFORM

• Prevention of cerebrovascular and cardiovascular
  Events of ischaemic origin with teRutroban in
  patients with a history oF ischaemic strOke or
  tRansient ischaeMic attack

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PERFORM

• Key criteria
• M or F, Age 55
• Ischaemic stroke
• 48hrs 3 months
• No other neuro disease
• No recent bleeding
• 4 year follow-up

• If Admitted to QEQM
• Stop drug (i.e. PERFORM)
• Notify
• Dr Guna
• Joan Idris (HCOOP x63031)

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CLOTS

• Clots in Legs Or sTockings after Stroke
• i.e. Do full-length graduated compression
  stockings reduce the frequency of DVT after
  stroke?

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CLOTS
Immobilised Stroke Patient Day 0-3 of Admission
RANDOMISE
Routine care avoid any GCS
Routine care full length GCS
Doppler of both legs at 7-10 days
Discharge Form Completed
Centralised 6 month follow up (questionnaire)
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DNA Lacunar

• Establishing a DNA database in young and
  middle-aged Caucasian lacunar (small vessel
  disease) stroke.
• Lacunar infarcts 25 of all strokes.

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DNA Lacunar

• Evidence that genetic factors are important
• Twin studies
• Family history
• Key criteria
• lt 65, Caucasian
• Up to 5 years post-stroke
• MRI Scan

• Blood samples
• ECCAC
• St Georges
• Central review of MRI and clinical history

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IST3

• A large-scale RCT of Thrombolysis for Acute
  Ischaemic Stroke.
• IV rt-PA (altepase) for acute ischaemic stroke
  within 6 hours of symptom onset, increases the
  proportion of people alive and independent at 6
  months

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IST3

• Key criteria
• Acute ischaemic stroke (not TIA. No haemorrhage,
  clotting or platelet defects)
• Time of onset known (treatment must be within 6
  hours)
• No age limit

Randomised to treatment or no treatment Repeat
brain imaging 24-48 hours Data collected at 7
days and 6 months
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COSSACS

• Continue Or Stop post-Stroke Antihypertensives
  Collaborative Study
• To assess whether continuing or discontinuing
  existing antihypertensive therapy within the
  first 48 hours following acute ischaemic or
  haemorrhagic stroke onset influences short- (2
  weeks) and long-term (6 months) outcome in terms
  of death and disability.

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COSSACS

• Key criteria
• gt18 years
• Clinical diagnosis of suspected stroke
• Stroke onset lt48 hours
• Currently taking antihypertensive therapy

• Randomise
• Continue/discontinue anti-hypertensive therapy
• At 2 weeks BP management at the discretion of
  clinician
• Data Collection
• Baseline, 2 weeks, 6 months

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TRACS

• TRAining Caregivers after Stroke
• A competency based caregiver-training programme
  (The London Stroke Carer Training Course, LSCTC)
  should improve patient outcomes in patients with
  disabling stroke.

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TRACS

• Key criteria
• Disabling stroke
• Will return home on discharge
• Caregiver available
• Caregiver patient consent

• Randomise to
• Intervention - receipt of structured LSCTC
  training
• Non-intervention usual care as per national
  guidelines
• Questionnaires (ADL QOL)
• patient and caregiver
• discharge, 6 and 12 months

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To find out more ...

• Dr Guna, Fordwich Ward, QEQM
• Email joan.idris_at_ekht.nhs.uk
• Web http//www.uksrn.ac.uk
• Web http//www.nihr.ac.uk/