Grant: Project Grant

Our study (DO IT) aims to improve the care of patients with stroke who are taking strong blood thinners (anticoagulants) at the time of their stroke. Stroke is the most common cause of physical disability in Canada. It often occurs when a blood clot clogs a blood vessel in the brain leaving it without blood flow and oxygen. One of the main treatments for strokes occurring due to blood clots is clot-busting medications (intravenous thrombolysis [IVT]) that can re-establish blood flow preventing brain damage. IVT is effective at reducing disability when given within 4.5 hours of start of stroke symptoms. However, many patients with stroke are on anticoagulants and are not currently receiving IVT due to concerns about the potential for increased risk of bleeding in these patients. The proportion of stroke patients taking anticoagulants is growing each year. Recent research suggests that IVT is safe and could prevent disability in stroke patients taking anticoagulants. DO IT aims to test whether IVT can improve functional independence without increasing the risk of bleeding in stroke patients taking anticoagulants. It will be a type of experiment known as a 'randomized trial.' Randomized trials are the most reliable tests of treatments. We will include 100 patients with stroke on anticoagulants who are otherwise eligible for IVT at 10 hospitals in Canada. These patients will be assigned at random, with a 50:50 chance of either receiving IVT or usual care (no IVT). Patients will be followed for 90 days after treatment. During this time they will be monitored for bleeding and the likelihood of regaining functional independence. We predict that patients who receive IVT will have a higher chance of returning to their pre-stroke level of function compared to those who don't receive it. The results of DO IT will have the potential to substantially improve the health of the 500,000 people who have a stroke while taking anticoagulants each year worldwide.