For the medical scene, this week has been phenomenal.
First, it was the low-dosage tuberculosis (TB) treatment which the World Health Organisation hailed as revolutionary in effectively treating the deadly disease. And now, scientists have found that lower doses of the most common clot-busting drug in stroke patients could save millions of life.
Every three seconds someone gets a stroke in India and every three minutes a person succumbs to it - precisely why the modified, shorter treatment which can save millions is really important to understand.
What Is the Role Of the Clot-Busting Drug In Strokes?
From two decades, a new type of fast-acting drugs, rtPA or alteplase, which dissolves the brain clots to let oxygen pass, has greatly improved survival rates and cut down on death and disability in those who got immediate medical aid.
From 1995 to 2016, even though these clot-busters have been controversial, they’ve been the gold standard in stroke treatment by doctors across the world.
What Does the Study Say
The George Institute of Public Health was done on more than 3,000 patients over three months, and it found that:
- The moment a brain stroke patient is hospitalised, cutting the dose of the clot-buster by a third can slash the risk of deadly brain bleeds by almost 70%
- 1 in 20 stroke patient dies from side-effects like internal bleeding
- And therefore, with a low dose the mortality rate came down from 10.3% to 8.5%
Researchers said that the findings can change the way the most common form of stroke is treated globally, including in India where an estimated 1.2 million people suffer from ischaemic strokes and the high cost of the drug, lack of health infrastructure and public awareness are the reasons for under-utilisation of this treatment.
The Drug Has Always Been Controversial
A study published in the British Medical Journal last year found that this popular clot buster, used across the world can have lethal side-effects.
In fact, this particular study went on to say that, more than three hours after a stroke, there is no clear benefit of this drug and there is a clear harm from increased death.
The dosage of this stroke first-aid medication was decided by a small-scale clinical trial done in US in the mid 90s. Since India was never big on R&D, our drug authorities obviously copied the dosage of this key, life saving drug set by America for its population.
21 years later, a three million dollar global study done the George Institute of Public Health with many Indian volunteers has found the high dosage of the life saving drug to be taking more lives than saving them.
Your Take Home Message
The good thing is, before you make life and death decisions about using this drug, you will now be fully aware of its benefits versus the risk ratio.
The catch is that it is largely unpredictable as to who will respond and who is at risk with rtPA. What we have shown is that if we reduce the dose level, we maintain most of the clot-busting benefits of the higher dose but with significantly less major bleeds and improved survival rates.Professor Jeyaraj D Pandian, Neurologist, Ex-Head, World Stroke Campaign
The tough part is that there is no way to know who is prone to internal bleeding and who is not.
For more than two decades we have been over simplifying the safety of this drug and as a result unwittingly contributing to thousands of unnecessary deaths. The big question is, when will our Drug Regulators be prompt enough to evaluate the safety of live-saving drugs on a regular basis?
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