New treatment protocol for brain hemorrhage improves chances of survival without major disability


The George Institute for International Health today announced data from the Phase 3 INTERACT3 trial demonstrating that a new treatment combination for stroke caused by intracerebral hemorrhage (ICH) significantly improves the chances of survival without significant disability announced.The results were presented today at the European Stroke Agency Conference in Munich, Germany, and at the same time lancet.

The INTERACT3 study is the first randomized controlled trial to show clearly positive results for the treatment of ICH. Timely implementation of new treatment protocols focused on rapid control of hypertension (known as care bundles) has improved recovery, reduced mortality, and reduced overall mortality in patients with this serious condition. improved quality of life.

Despite the high incidence and severity of ICH, there are few proven treatment options, but early control of hypertension holds the greatest promise. Because time is critical when treating this type of stroke, we tested a combination of interventions to rapidly stabilize the condition and improve outcomes in these patients. We estimate that tens of thousands of lives could be saved worldwide each year if this protocol were widely adopted. “


Professor Craig Anderson, Director of Global Brain Health, The George Institute, Lead Study Author

ICH, commonly referred to as hemorrhagic stroke or intracerebral hemorrhage, is the second most common type of stroke and the most fatal, with 40% to 50% of patients dying within 30 days. It is caused by blood leaking from blood vessels into brain tissue and accounts for more than a quarter of stroke cases, affecting about 3.4 million people annually.

The INTERACT3 study enrolled over 7,000 patients in 144 hospitals in 10 countries, including 9 middle-income and 1 high-income countries.

The research team evaluated the efficacy of new care bundles including early intensive systolic blood pressure reduction, tight glycemic control, fever treatment, and rapid recovery from abnormal anticoagulation therapy.

They found that compared to usual care, using this new treatment protocol reduced the likelihood of dysfunction, including death, after 6 months. It was estimated that this would prevent him from 1 additional death for every 35 patients treated.

The central factor was the rapid decrease in systolic blood pressure, reaching target levels in an average of 2.3 hours. [range 0.8 to 8.0hrs]compared to 4.0 hours [range 1.9 to 16.0hrs] in the control group. This intervention protocol resulted in statistically significant reductions in mortality, number of serious adverse events, and hospital stay, demonstrating improved health-related quality of life.

The burden of intangible cultural heritage is greatest in low- and middle-income countries. In 2019, ICH accounted for 30% of all stroke cases in LMIC, almost double the rate seen in high-income countries (16%). This is partly due to high hypertension rates and limited resources for primary prevention strategies, including the identification and management of stroke risk factors by health services.

“The lack of proven treatments for ICH has led to a pessimistic view that there is not much that can be done for these patients,” said co-author Lili Song, Ph.D., director of the China Stroke Program at The George Institute. However, INTERACT3 states, “We have demonstrated at scale that in resource-limited settings, readily available therapies can be used to improve outcomes. We hope to inform clinical practice guidelines and save many lives.”

sauce:

George Institute for Global Health

Reference magazine:

Ma, L, other. (2023) The 3rd Intensive Care Bundle Trial with Blood Pressure Reduction in Acute Cerebral Hemorrhage (INTERACT3): An International Stepwise Wedge Cluster Randomized Controlled Trial. lancet. doi.org/10.1016/S0140-6736(23)00806-1.



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