New trial could prevent further strokes and reduce hospital time

Atrial fibrillation (AF) is a heart rhythm disturbance that affects many people as they get older. It results in an irregular heartbeat, which can lead to a clot forming inside the heart. This clot can travel to the brain, blocking its blood supply and causing a stroke.

More than 1.3 million people in the UK have been diagnosed with AF – and they are five times more likely to have a stroke than people without AF. Those who have suffered a stroke due to AF are at increased risk of having another stroke, which can be reduced by taking blood thinning medicines.

But a rare but dangerous side effect of blood thinning medicines is bleeding into the brain – and there is a lack of evidence about when best to commence them after a stroke.

David Werring, Professor of Clinical Neurology at University College London Institute of Neurology, will now lead a clinical trial to determine the best time to start taking blood thinning drugs after a stroke caused by AF.

The British Heart Foundation (BHF) has awarded Professor Werring and his team more than £2 million to address this question.

The OPTIMAS trial will compare the effects of starting the newest type of blood thinning medicine (called a DOAC) less than four days after stroke with the current practice of waiting seven to fourteen days.

More than 3,000 people from over 100 UK hospitals who have had a stroke due to AF will be recruited into the trial. Half will start blood-thinning medication earlier, and half will start them later. Information about their health and progress over 90 days after their stroke will be analysed to see which treatment time is most beneficial.

Professor Werring said: “Every day in the UK there are around 690 hospital visits due to a stroke – we want to slash this number and reduce the risk of further complications by delivering safer and more effective treatments.

“The results of OPTIMAS could transform the way we treat patients with AF-related stroke by ensuring that they receive the correct treatment as soon as possible, and spend less time in hospital and more time at home with their families.”

On top of boosting people’s health, reducing the number of recurrent strokes would deliver major economic benefits to our economy – the approximate cost per patient is around £45,000 in the first 12 months after stroke.

Dr Shannon Amoils, Senior Research Advisor at the BHF, added: “Clinicians treating people with stroke after AF have to strike a delicate balance to deliver optimal care. Ideally, they would like to restart anticoagulant drugs sooner rather than later to lower the risk of another AF-related stroke – but they must also consider the risk of bleeding.

“We’re delighted to be funding the OPTIMAS trial, which will provide stroke doctors with the evidence to make this important clinical decision.

“Funding for this research has only been made possible by the generosity of our supporters. We rely on their support to fund more research and deliver on our mission to beat heartbreak forever.”

This work is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.