statins in stroke

Press release

Statins still not prescribed at Discharge among 1 in 4 Stroke Patients inspite of large awareness campaign.

Current guidelines call for in-hospital initiation of statin therapy for patients with stroke or transient ischemic attack (TIA) of atherosclerotic origin and continuing statin therapy in stroke patients at the time of discharge.

However, an observational study conducted in Ratnagiri which was supported by The Niramal Clinics finds that 1 in 4 of these patients is still not prescribed statins at hospital discharge and that reports from clinical trials documenting the effectiveness of statins in secondary stroke prevention apparently had no lasting impact on clinical practice. This is inspite of the fact that the cost of statins have come down significantly after many Indian companies have started maufracturing the medicine.

Incidentally I came to read a good article related to the issue in which a very large cohort was studied. "Approximately 1 in 10 stroke patients experience another stroke within a week," said lead study author Bruce Ovbiagele, MD, MsC, director of the UCLA Stroke Prevention Program at the University of California, Los Angeles. "The hospital encounter provides a window of opportunity to ensure prompt and appropriate initiation of treatments, such as statins, that could prevent another stroke."

A simple observation and recording of prescriptions were done in indoor patients and OPD patients following up with another doctor to assess trends in discharge statin treatment and to see whether such treatment changed in response to dissemination of results from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. They also analyzed factors that might predict whether patients would get statins or not. The study pattern was not revealed to any colleague doctor to avoid bias factor. The study lasted for a period of about 9 months and involved 500 entries.

During the study period, discharge statin prescription rates climbed "steadily but modestly," they write, from 75.7% to 84.8%. Young doctors were found to more often omit a statin prescription. General practitioners were more consistent with prescriptions. Combination medications were less used though they had the benefit of cost control and patient compliance. Patients who presented with TIA rather than ischemic stroke, who had known coronary artery disease, or who had known peripheral vascular disease were also less likely to receive discharge statin prescriptions. An estimated 28% patient were not prescribed statins though it was indicated.

"While statin use after stroke improved over time, 28% of eligible stroke patients still leave the hospital without statin treatment, which unnecessarily exposes them to the risk of another stroke. Colleague doctors should take note of this and update themselves about these newer protocols. It may be worth educating the population about these medicines, as has been done in many advanced countries, since they have the potential to reduce the economic and social burden of paralysis " Dr. Pratyush Chaudhuri said.

This study was funded by the Nirmal clinics, Ratnagiri.

Press Release: Embargoed until 00.01 am British Summer Time on Tuesday 15th June 2010

Simple Injection Could Save the Lives of Thousands of Accident Victims Worldwide

If recently injured patients with serious bleeding were to receive a cheap, widely available and easily administered drug to help their blood to clot, tens of thousands of lives could be saved every year, according to a paper published on-line on Tuesday 15 June by the medical journal, The Lancet.

The results of the international CRASH-2 trial, show that early administration of tranexamic acid (TXA) to patients with recent, severe bleeding injuries saves lives, with no evidence of adverse effects from unwanted clotting.

The CRASH-2 trial was a large, randomised trial involving over 20,000 adult patients in 274 hospitals across 40 countries. It is the first trial of TXA in injured patients, although smaller trials have shown that it reduces bleeding in surgical patients.

Dr Pratyush Chaudhuri from Parkar Hospital was actively involved in the research and recruited 102 during the four years of trial recruitment.

The drug helps by reducing clot breakdown. Although this would be advantageous in patients with severe bleeding, doctors were worried that TXA might increase the risk of complications, such as heart attacks, strokes and clots in the lungs. The results of this trial show that TXA reduces death from bleeding without any increase in these complications.

Severely injured adults were enrolled in the trial if they had significant bleeding, or were at risk of significant bleeding and were within a few hours of injury. The researchers studied the numbers of deaths in hospital within four weeks of injury in the group and found that TXA reduced the chances of death due to massive blood loss by about one sixth.

The researchers estimate that administering TXA soon after injury could prevent up to 100,000 deaths per year across the world. “In India this treatment could prevent 12865 deaths, which amounts to about 18% of deaths due to severe haemorrhage, each year said Dr Pratyush Chaudhuri

Dr Pratyush Chaudhuri said about the results “this study provides us a simple and affordable tool , particularly relevant for developing countries where emergency services for trauma is rarely available in time]”


Contact:
To interview Dr. Pratyush Chaudhuri, contact 9226711139 , pratyushchaudhuri@email.com, www.drpratyush.hpage.com, www.thinkoblique.blogspot.com

My vision of the future Nirmal Hospital

Monument for the proposed Nirmal centre for science and art.

Sketch of third ventricular colloid cyst -inter-hemisphere trans callosal approach.

Shiva the drum beater of eternity

Sublime clock.