Lower dosage better for stroke patients: Study

FINE BALANCE: What we seek is a very high degree of precision in balancing the risks versus benefits of a lower dose of (intravenous alteplase), so that we can act safely and effectively for every patient. - ASSOCIATE PROFESSOR VIJAY SHARMA (above),
FINE BALANCE: What we seek is a very high degree of precision in balancing the risks versus benefits of a lower dose of (intravenous alteplase), so that we can act safely and effectively for every patient. - ASSOCIATE PROFESSOR VIJAY SHARMA (above), who led the reseachers in the study

33% drop in dosage resulted in 19 fewer deaths per 1,000 patients, much cheaper bills for medicine

Stroke patients who receive a lower dosage of intravenous alteplase - a medication commonly used to treat strokes - have a higher chance of survival, a recent study found.

Conducted by researchers from the National University Health System (NUHS), the study covered over 3,000 stroke patients globally, 25 of whom were from Singapore.

The study found that a 33 per cent reduction in dosage resulted in 19 fewer deaths for every 1,000 patients. The cost of the medication was also reduced by half.

The study applies to patients who suffer from ischemic stroke, which occurs as a result of blood clots in vital arteries in their brain. These blood clots can be dissolved by intravenous alteplase, which has side effects that include a risk of internal bleeding in the brain.

Reducing the dosage lowers this risk which, in turn, raises the patient's chances of survival.

The team of researchers, led by Associate Professor Vijay Sharma, senior consultant at the Division of Neurology at NUHS, began the study's clinical trial in 2009.

The main aim of the study was to improve the survival rate of stroke patients while maintaining safe medical procedures.

Prof Sharma said: "Reducing the dose to help the patient recover whilst reducing the risk of bleeding is now feasible. Being alive with some recovery... is surely preferable to most patients than early death."

While the research may not change official medical guidelines, the team says it could be incorporated into guidelines when dealing with high-risk stroke patients.

There are plans to advance the study over the next two to three years by looking into other aspects of the treatment, said Prof Sharma.

This involves studying how patients with different blood pressure levels could be affected by the lowered dose.

"What we seek is a very high degree of precision in balancing the risks versus benefits of a lower dose of (intravenous alteplase), so that we can act safely and effectively for every patient.

"Annually, on a global scale, improving a complication rate by just one per cent has the potential to save tens of thousands of people."

In Singapore, the National Registry of Diseases Office cited 6,642 new stroke cases for 2013 alone.

A version of this article appeared in the print edition of The Straits Times on May 27, 2016, with the headline 'Lower dosage better for stroke patients: Study'. Print Edition | Subscribe