Stroke is one of the leading causes of death and disability. Other than aspirin, the only approved treatment for people having an acute ischaemic stroke (caused by a blood clot) is the clot-busting drug called Alteplase. The treatment can be risky, especially in people who have high blood pressure when they arrive at the hospital. One of the most devastating side effects of clot-busting treatment is bleeding into the brain, which occurs in approximately 5% of treated patients. This research will examine ways of reducing this complication, thereby improving patient outcomes; promoting reduced long-term disability and increased independence and consequently quality of life.
ENCHANTED is an international trial designed to address two key questions in the treatment of stroke patients with the clot-busting drug, Alteplase. Firstly, does giving the patient a lower dose of Alteplase have the same effect and give the same benefit as the standard-dose, and does the lower dose reduce the risk of bleeding into the brain as a complication of the treatment?
Secondly, if we act to lower the blood pressure in people whose blood pressure is high when they have their stroke, before we give them the clot busting treatment, does this intensive blood pressure-lowering improve their outcomes compared to current guideline treatment, which is not to lower the blood pressure. We will also answer whether lowering blood pressure reduces the risk of bleeding into the brain as a complication of clot-busting treatment in patients with high blood pressure.