The PREVAIL Study

lnterventions in stroke can greatly improve patient National Institute of Health Stroke Scale) than
outcomes. the unfractionated heparin group. There was no
di fference n cl i n ical ly-sign ifl cant bleed ng rates,
i

Thrombolysis Inside the beneflt window of 48 hours this is

We should make thrombolysis available to as many positive for enoxaparin as a bene{lcial agent for
stroke patients as possible within three hours of naticntc rrrith cinnLa

symptom onset. lmprovement in outcome can be

significant w;thin this period and treatment is cost
effective. Howeven thrombolysis is complex to
administer: it is unavailable in more rural areas and
it is hard to identify candidates fortherapy
emergency department,
Conclusion
The stroke unit is one of the most powerful
interventions that we can provide stroke patients.
in the These in combination with newer more effective
agents will optimise outcomes,

Stroke units
Anorher intervention Lhat can dramaticalry change
the outlook for strol<e patrents is provision of
care in a stroke unit. These constitute a much
more powerful intervention than many drugs.
The number needed to treat (NNT) in a stroke
rrnit to nrcvent nnc dp:th i< ?? ta nra\/ant Ana
" '"-r'
admissionto institutional care, which costs
between A$ 60,000 and 80,000 a year, the
NNT is 14.

DVT prophylaxis
Most stroke in Australia is ischaemic, so
deep vein thrombosis (DVT) prophylaxis has
to cater to ischaemic srrol<e patients, who
have an extraordinarily high risk for DVT,
Throm boprophylaxis either using unfractionated
heparin or the lower molecular weight heparinoids
is effective and is now recommended as the
standard ofcare.

The PREVAIL Study

In PREVAIL. approximately I B0O patients who
had an ischaemic stroke con{lrmed radiographically
within 48 hours of symptom onset, were
randomised to prophylactic enoxaparin once
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The enoxaparin group experienced significantly
The following references were cited by the presenter:
fewer venothromboembolism events (43%
relative risk reduction) and proximal deep vein Albers GW et al. Chest 2004; 126: 483-512
Begirlstain JM et al. Cerebrlvascular disease 2005; 20(3): 193-200
thrombosis (53% relative risk reduction) regardless
Stroke Unit Trialists' COiiab0rati0n, BMJ i997;314: 1 151-9.
of sLroke severiry (stratified accordrng to the Sherman DG et al, Lancet 2007; 369(9570):
.1347-55.