UK-led stroke research has made major contributions to developments in areas like anti-platelet agents, carotid endarterectomy, carotid stenting, surgical management of intracranial haemorrhage and rehabilitation in recent years.
UK research groups have contributed to national and international guidance on stroke care:
- 36% of research references underpinning NICE guidance identified in systematic reviews
- 42% of key references in European Stroke Organisation’s guidelines for management of ischaemic stroke
Changing clinical practice: the CLOTS trials
Immobile patients face a 10-20% risk of deep vein thrombosis (DVT) during the first month after stroke. The CLOTS - or 'Clots in Legs Or sTockings after Stroke' studies are testing graduated compression stockings for DVT prevention in acute stroke patients.
Findings from the CLOTS 1 trial were published in The Lancet in May 2009:
- 200 patients would need to be fitted with thigh-length GCS to prevent one proximal DVT
- Two-thirds of DVTs prevented would be without symptoms
- Patients in the interventional group had significantly more problems with skin ulcers, blisters and ulceration
As a result, NICE revised its stroke guidelines in early 2010, and no longer recommend thigh-length GCS for stroke patients.
Hyperacute Stroke Research Networks
In June 2010 the Stroke Research Network launched eight Hyperacute Stroke Research Centres (HSRC's) across England; providing patients with round the clock access to clinical research into breakthrough stroke treatments. At the time a number of NHS Trusts had developed dedicated 'fast response' stroke units capable of providing specialist 'clot busting' therapies within hours of stroke onset. This had a major impact on stroke treatment, but unitl the HSRC's were introduced just over three years ago, there had been limited means to undertake research in this vital area.
Hyperacute Stroke Research Centres have changed this by increasing research capability and capacity. The centres are staffed by multidisciplinary research teams - including clinical stroke specialists, research nurses, radiographers and interventional neuroradiologists - who can provide out of hours cover in evenings and at weekends to ensure that any patient suffering a stroke can take part in pioneering research at any time of day.