Stroke units, tissue plasminogen activator, aspirin and neuroprotection: which stroke intervention could provide the greatest community benefit?
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.
Gilligan
Amanda K
AK
Department of Neurology, Austin and Repatriation Medical Center, Heidelberg, Australia.
Thrift
Amanda G
AG
Sturm
Jonathan W
JW
Dewey
Helen M
HM
Macdonell
Richard A L
RA
Donnan
Geoffrey A
GA
D000208:Acute Disease; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D018696:Neuroprotective Agents; D010959:Tissue Plasminogen Activator; D001241:Aspirin