Tranexamic acid is a cheap drug. It costs less than £15 per patient and is widely available. It could transform treatment of stroke caused by intracerebral haemorrhage.
I should know, I led the research study at the University of Nottingham’s Stroke Trials Unit that made the finding. What I also know is that vital stroke research like this is just not possible without research nurses.
Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability. The cost to the NHS is estimated at more than £3 billion.
Currently, there is no drug treatment option for patients with bleeding in the brain (intracerebral haemorrhage), a condition that affects 22,000 people every year.
In response I led TICH-2, a stroke study funded and supported by the National Institute for Health Research (NIHR). The study tested tranexamic acid, a drug currently used to treat excessive blood loss from major trauma and childbirth. Although there was no significant difference in the primary outcome of death or dependency at 90 days, there was a significant reduction in the amount of bleeding on the brain, serious complications and early deaths in the first week, for patients who received the treatment.
“A study of this scale and complexity would just not have been possible without the support of the NIHR”
TICH-2 was the largest international study of its kind, involving some 2000 participants from across 12 countries. Over 1,700 of these patients were recruited across 84 hospitals in the NHS in England.
A study of this scale and complexity would just not have been possible without the support of the NIHR and access to essential facilities and staff.
As well as clinical nurses providing high-quality patient care, research nurses were key to the rapid recruitment of patients, getting emergency consent, giving patients a drug treatment quickly and following up properly.
They also played a key role as advocates for patient and their relatives, ensuring they were well supported throughout the study and had a good understanding of their condition and treatment options.
“The goal of research is to provide the vital evidence on what works”
The goal of research is to provide the vital evidence on what works, so we can keep improving treatments for patients. And it’s research nurses, working with doctors and researchers, who are helping make sure the NHS can meet the challenges of the future. We’ve come a long way too.
In 2005, less than 1% of stroke patients were recruited to research studies. But over the last twenty years, stroke mortality rates have halved. The NIHR research has played a huge part in this transformation.
We’ve delivered a number of large stroke studies from looking at the effectiveness of compression stockings in reducing the risk of post-stroke deep vein thrombosis, to studying the benefits of a clot-busting drug in older people more than three hours after symptoms begin.
The UK is now a ‘go-to’ place when it comes to stroke research. Alongside ten Hyperacute Stroke Research Centres across England, who admit high volumes of stroke patients and have a team of dedicated research staff, there are many smaller sites, such as district general hospitals, with one or two research nurses that are just as crucial to the success of research.
Clinical research is vital to improving patient care. Studies can offer patients the opportunity to access innovative treatments and procedures they wouldn’t otherwise have had. Without research nurses, large studies such as TICH-2 just wouldn’t happen and treatments of the future would be lost.
As we strive to answer the important unanswered questions in stroke, our priority is always the patient – the expertise, experience and dedication of research nurses ensures it remains so.
Nikola Sprigg is National Institute for Health Research stroke specialty lead for East Midlands and Professor of Stroke Medicine at the University of Nottingham.