In a significant development for stroke prevention, an experimental drug designed to block blood-clotting proteins shows potential in lowering the risk of recurrent strokes.
This finding comes from a dose-finding trial published in The Lancet Neurology.
Stroke is a major health concern in the United States, with over 795,000 people affected each year, according to the American Heart Association. Notably, nearly one in five of these individuals will experience another stroke.
Despite existing medications to prevent subsequent strokes, the risk remains high, which is a source of frustration for both patients and healthcare providers, as explained by Dr. Richard Bernstein, a professor at the Ken and Ruth Davee Department of Neurology’s Division of Stroke and Vascular Neurology.
The cumulative impact of recurrent strokes can be severe, often leading to the need for long-term care. To counter this, patients who have had a minor stroke are usually given medications to prevent blood clots.
Interestingly, past research has indicated that people with low levels of factor XI—a protein involved in blood coagulation—have a reduced rate of ischemic strokes, where blood clots obstruct blood flow to the brain.
This insight led to the trial involving the drug milvexian, which inhibits factor XI. Over 2,300 participants in the trial were given various dosages of milvexian alongside standard anti-blood clotting medications.
The results after 90 days were promising. MRI imaging showed that participants who received 50–100mg of milvexian twice daily had a slightly lower risk of recurrent stroke compared to those who received a placebo.
Dr. Bernstein highlights that milvexian appears to prevent clinical stroke, although more research is needed to confirm this fully.
A critical aspect of this study was determining the optimal dosage of milvexian that balances reducing stroke risk without significantly increasing bleeding risk.
An interesting takeaway from this study is the realization that using MRI to count strokes may not be the most effective method to assess the efficacy of such drugs.
The next steps, as outlined by Dr. Bernstein, involve using the study’s findings to pinpoint a recommended dose for a larger clinical trial.
This upcoming trial will compare standard therapy alone versus standard therapy plus milvexian, focusing on the rate of stroke reduction and bleeding risks over 90 days.
If successful, milvexian could become a new tool in preventing recurrent strokes, addressing a critical need in stroke management and patient care.
If you care about stroke, please read studies about how to eat to prevent stroke, and diets high in flavonoids could help reduce stroke risk.
For more information about health, please see recent studies about how Mediterranean diet could protect your brain health, and wild blueberries can benefit your heart and brain.
The research findings can be found in The Lancet Neurology.
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