Tens of thousands of lives a year could be saved by new treatment protocol for brain hemorrhage

Newswise — The George Institute for Global Health recently revealed findings from the phase III INTERACT3 trial, showcasing that an innovative treatment amalgamation for intracerebral haemorrhage (ICH) stroke notably enhances the probability of survival without significant impairment. The outcomes were disclosed today at the European Stroke Organisation Conference held in Munich, Germany, and simultaneously published in The Lancet.

The INTERACT3 trial marks a groundbreaking milestone as the inaugural randomized controlled study to demonstrate a distinctly favorable result in the management of ICH. Prompt implementation of the novel treatment approach, referred to as a Care Bundle, focused on expeditiously regulating elevated blood pressure, resulted in enhanced recuperation, reduced mortality rates, and an overall improvement in the quality of life for individuals affected by this critical ailment.

Professor Craig Anderson, the Director of Global Brain Health at The George Institute and a senior researcher involved in the study, expressed, "In spite of the elevated prevalence and gravity of ICH, the available treatment options are limited. However, early management of high blood pressure holds the greatest promise. Given the time-sensitive nature of treating this form of stroke, we conducted a trial that combined interventions aimed at swiftly stabilizing the patients' condition to enhance their prognosis. We project that if this protocol were universally implemented, it has the potential to save tens of thousands of lives annually worldwide."

ICH, commonly known as a haemorrhagic stroke or brain bleed, holds the distinction of being the second most prevalent form of stroke and the most fatal, as 40% to 50% of patients succumb within 30 days. This condition arises when blood seeps out of a blood vessel into the brain tissue, constituting more than a quarter of all stroke cases and impacting approximately 3.4 million individuals annually.

Within the INTERACT3 investigation, a comprehensive enrollment of over 7,000 patients was undertaken, involving 144 hospitals spanning across 10 countries. These countries comprised nine middle-income nations and one high-income nation.

The research team meticulously assessed the efficacy of the novel Care Bundle, encompassing various essential components. These included the early and intensive reduction of systolic blood pressure, stringent control of glucose levels, targeted management of fever, and prompt correction of abnormal anticoagulation.

The study findings revealed that implementing this new treatment protocol, in comparison to conventional care, significantly decreased the probability of an unfavorable functional outcome, encompassing mortality, at the six-month mark. The analysis projected that for every 35 patients subjected to this protocol, one additional death could be prevented.

A crucial aspect of the intervention was the swift reduction of systolic blood pressure, with target levels typically attained within 2.3 hours (ranging from 0.8 to 8.0 hours), in contrast to the control group's average time of 4.0 hours (ranging from 1.9 to 16.0 hours). The implementation of the interventional protocol led to a statistically noteworthy decrease in mortality, the occurrence of severe adverse events, and hospitalization duration. Additionally, it demonstrated an enhancement in health-related quality of life.

The impact of ICH is particularly significant in low- and middle-income countries (LMICs). In 2019, ICH accounted for 30% of all stroke cases in LMICs, which is nearly double the proportion observed in high-income countries (16%). This disparity can be attributed, in part, to the elevated prevalence of hypertension and limited resources available for primary prevention strategies, including the identification and management of stroke risk factors by healthcare services in LMICs.

Dr. Lili Song, the joint lead author and Head of the Stroke Program at The George Institute China, expressed, "The absence of established treatments for ICH has fostered a pessimistic outlook, suggesting limited options for these patients. However, through the extensive scope of INTERACT3, we have demonstrated how readily accessible treatments can be utilized to enhance outcomes, even in settings with limited resources. We aspire for this evidence to inform global clinical practice guidelines and contribute to saving numerous lives."