When stroke strikes, clinical trial decisions need to be made quickly

What comes to mind when you think of clinical trials? If you’re like most people, you think of cancer or other longer-term diseases in which people have time to weigh the benefits and risks before signing the forms to participate.  

This isn’t how it works when it comes to clinical trials for stroke – at least when initially treating a stroke.  

Strokes typically strike out of the blue. Because time is of the essence, we have to give patients and families a crash course in stroke treatment. We’re sensitive to the fact that our patients and their loved ones must absorb a lot of important information very quickly. But we also know that at times a clinical trial may be a patient’s best chance for recovery – and there’s limited time to decide whether to participate.  

Hopefully, you’ll never need to put this information to use, but if you or a loved one is at risk for stroke, take time to learn what questions to ask about clinical trials in the short time you have to make a decision.  

Questions to ask when considering a clinical trial

We participate in observational trials as well as trials in early and later phases through our National Institutes of Health (NIH)-funded stroke clinical research programs: NIH/NINDS Intramural Stroke Program and NIH StrokeNet: Stroke National Capital Area Network for Research (SCANR).

We conduct trials at every stage of stroke:

  • Acute, or immediately after it happens
  • Rehabilitation
  • Preventing another stroke  

Read more about our current and completed stroke trials and studies or find additional stroke-related clinical trials.  

In trials for acute stroke, the decision to participate needs to be made quickly. When it comes to rehabilitation and preventing another stroke, you may have some time to research and think through your options. We know you’re getting a lot of information thrown at you in a short time, but there are a few things you should ask and understand before you decide – whether for yourself or a loved one. 

What’s the standard treatment?

There are two main types of stroke:  

  • Ischemic, in which a clot blocks blood from reaching the brain
  • Hemorrhagic, in which a blood vessel bursts and leaks blood into the brain  

Treatment for either type of stroke may include a clot-busting drug, such as tissue plasminogen activator (tPA), which is the gold standard for treating ischemic strokes. We also may be able to physically remove the clot or repair the vessel to prevent further bleeding.  

Why would a clinical trial be better than the standard treatment?

Some people may not be good candidates for standard stroke treatment. For example, tPA must be given within four-and-a-half hours of the onset of the stroke, and clot retrieval for a subset within six hours of the onset of the stroke, as the bleeding risk and other potential complications may outweigh the potential benefit after that time for most patients. In these cases, a clinical trial may be your best or only option.  

In some situations, a clinical trial may offer a better chance of recovery than the standard treatment, and your doctor should explain why this may be.

 What are the risks and benefits to participating?

Every treatment has potential side effects. Ask what these may be in the short-term and the long-term. Also, learn how the possible risks and benefits compare to those of the standard treatments.  

The benefits can range from the potential for a better recovery or, in the case of an observational study in which you’ll get standard treatment, contributing to and advancing our knowledge of stroke care.  

Advocate for yourself and loved ones

Unfortunately, if you’re told that you or a loved one is not a candidate for standard stroke treatment, there’s no time to go home and Google “clinical trials.” However, that doesn’t mean there’s nothing you can do. You’re your best advocate.  

First, research your local hospitals to learn what stroke resources they offer in the way of specialists, treatments and clinical trials. Ask which facilities they turn to for additional guidance.

If you’re taken to a hospital that doesn’t offer clinical trials, ask the doctor if there is one available in the greater area that you may be eligible for. Our StrokeNet clinical trials network includes multiple hospitals in the mid-Atlantic region, so depending on the trial, you may be closer to a participating hospital than you think.  

We want to help as many stroke patients as possible, but we can’t help if we don’t know who they are. We rely on emergency medicine doctors to notify us about potential candidates – and quickly. We are developing a process through our telestroke program to expand clinical trial access to stroke patients at other hospitals. But for now, asking about potential trials in the area may prompt the doctor to give us or another facility a call.  

While you likely will never be fully prepared for the shock of having a stroke, having some knowledge of clinical trials in the back of your mind may make an emergency situation a little less stressful.  

Request an appointment to learn more about our stroke clinical trials and to discuss whether you or a loved may be a candidate for one. 

 

(In the photo: Stroke team evaluates a patient. (L to R) Adey Haile-Mariam, RN, nurse responder team, Carlos Portillo, MRI technologist and Dr. Amie Hsia)

Stroke: A young person’s disease?

If you think you’re too young to have a stroke, think again. A study published in April 2017 showed that the rate of stroke among young people has risen dramatically in the past 15 years. The data didn’t surprise me at all. I’ve witnessed this trend firsthand in Washington, D.C.

Most people think of stroke as something that strikes older adults, but the study showed that between 2003 and 2012, stroke rates increased nearly 42 percent among men ages 35 to 44, and 30 percent for women in that age group.

A recent study shows that #stroke rates are increasing in younger adults – up to 42% in men ages 35-44 since 2003.

I’d say the average age of our patients is 40 to 60. When you compare this with our National Institutes of Health extramural stroke program partner Suburban Hospital in nearby Bethesda, Md., you can see where demographics and overall health comes into play. The average age of their stroke patients is 70 to 90.

The Bethesda community is primarily made up of white residents who have fewer health complications. D.C. has a larger population of African-Americans, who are at greater stroke risk overall, and more people with stroke risks such as obesity and high blood pressure.

Let’s take a closer look at why younger adults are at greater risk for stroke than ever before, and what you, health professionals and the community at large can do to turn this trend around.

Why stroke risk has increased in younger people

Stroke risks fall mainly into two levels: non-modifiable risks, which you have no control over, and modifiable risks, which are within your control to manage and treat.

Non-modifiable risk factors include:

  • Age: Your risk of stroke nearly doubles every 10 years after the age of 55.
  • Gender: Men have a higher stroke risk than women.
  • Race and ethnicity: The risk for stroke is two times higher for African-Americans and 1.5 times higher for Hispanics than for whites.
  • Family history: If a grandparent, parent or sibling has had a stroke, particularly before the age of 65, you may be more at risk.

Modifiable risk factors include:

It’s these modifiable risks that are the primary reason stroke rates for younger adults are rising. The 2017 study found that the number of men and women between age 18 and 64 with these conditions increased across the board, as did the prevalence of having three or more of these risk factors. 

The danger of overlooking stroke symptoms

While not a true risk factor, younger adults often face another danger: their feeling of invincibility. Young adults tend to overlook the signs of a stroke. They think they’re too young and what’s happening couldn’t possibly be a stroke. This can lead to a delay in treatment, and in a condition where seconds matter, this can be devastating to survival and recovery.

The gold standard for treating ischemic strokes is tissue plasminogen activator (tPA), a clot-busting drug. However, tPA must be given within four and a half hours of the onset of stroke to work effectively. Younger people, if treated in a timely manner, often have a better chance of recovery because their brains have greater plasticity. The surviving cells take over for those that are killed off by the stroke. We lose some of that regeneration as we age.

Rehabilitation also can be impeded by the presence of health problems such as diabetes, high blood pressure or cholesterol.

Stroke is the fifth leading cause of death in the United States, and the leading cause of disability. It costs the country $33 billion a year in healthcare services, medicines and missed days of work. When someone has a stroke during their most productive years, it can cost even more – not just in money but in quality of life as they may require more years of care and missed work.

Know the signs of stroke and never think you’re too young to have one. Use the acronym FAST to quickly identify common stroke symptoms:

  • Face: Can you smile? An inability to smile or a one-sided expression can indicate a stroke.
  • Arms: Can you raise both arms? One-sided muscle weakness or paralysis can indicate a stroke.
  • Speech: Can you say a simple sentence? Slurred speech or difficulty speaking are signs of a stroke.
  • Time: Call 911 immediately if you notice these symptoms.

Other signs to be aware of include:

  • Sudden vision trouble in one or both eyes
  • Sudden severe headache with no known cause
  • Sudden confusion or trouble understanding
  • Sudden trouble walking, dizziness or loss of balance or coordination

How young adults can reduce risk factors for stroke

As with any health condition, prevention is the best medicine, and stroke is no different. Fortunately, many stroke risks can be prevented, managed or treated if they appear.

A good start to reduce your risk of stroke is to develop a healthy lifestyle:

  • Eat a healthy diet.
  • Stay physically active.
  • Don’t smoke. Ask for help to stop smoking.

One in three adults in the U.S. have high blood pressure, but only about half have it under control. And many younger adults don’t even know they have it. See your doctor for an annual exam, and if it’s discovered that your blood pressure is high, follow recommendations to lower it.

If you’ve been diagnosed with diabetes, monitor your blood sugar and use medicine, diet and exercise to keep it within the recommended range. One in three people have prediabetes, a condition in which blood glucose levels are higher than normal. Talk with your doctor about how to prevent or delay the onset of diabetes.

There are also steps we can take as a community to lower stroke risk. One is to continue and expand nutritional programs, especially in our schools. We want our children to learn healthy eating habits early in life. It should be a given that any meal served in our schools is a healthy one.

We also must work together to address food deserts, those neighborhoods in which there is a lack of fresh fruit and vegetables and other healthy foods. These areas lack grocery stores and farmers’ markets, so people can’t buy healthy foods to make at home. Vending machines in our public spaces and workplaces often offer few healthy choices, so we can work to improve the available options.

Exercise does wonders for our health. It lowers weight, stress, blood pressure, blood sugar and cholesterol. We must create opportunities to promote physical activity and access to suitable spaces – indoors and out.

This trend of younger people having strokes is alarming, but it’s reversible. With hard work from younger adults, health professionals and the community, we can better manage those modifiable risk factors and reduce our risk of stroke.