Third International Stroke Trial

Stroke is a common disease. Every year, stroke kills about 5 5 million people around the world (1). Almost 5 billion years of healthy life are lost as a result of yearly strokes (1). In the United Kingdom, it is the single most expensive condition looked after by the National Health Service, costing 2 8 billion pounds (5 2 billion US dollars) in direct care costs alone (2). In Europe, Australia and the United States, about 80% of strokes are ischaemic (3). Unfortunately, ischaemic stroke has few effective treatments. Coordinated stroke unit care reduces the number of patients left dead or dependent due to stroke by 56 per 1000 patients treated (3). Once established, stroke units can care for most patients with stroke, so that their effect on improving outcome is larger than any other treatment. Treatment with aspirin soon after ischaemic stroke reduces the chance of death or disability by about 12 patients per 1000 treated, probably by reducing the chance of stroke recurrence (4). Although the treatment effect is small, aspirin is cheap and widely applicable so it too has a large effect on reducing the overall burden of disability from stroke. Thrombolysis for stroke with recombinant tissue plasminogen activator (rtPA) is effective, though expensive and difficult to deliver, and currently applicable to only a small group of patients. Consequently, the impact of thrombolysis on reducing stroke-related disability in the population from stroke is currently relatively small (5). Only stroke units and aspirin are in widespread use for the treatment of acute ischaemic stroke.