Stroke Units, Tissue Plasminogen Activator, Aspirin and Neuroprotection: Which Stroke Intervention Could Provide the Greatest Community Benefit?

Background: Although a number of acute stroke interventions are of proven efficacy, there is uncertainty about their community benefits. We aimed to assess this within a defined population. Methods: Eligibility for tissue plasminogen activator (tPA), aspirin, stroke unit management and neuroprotection were assessed among incident stroke cases within the community-based North East Melbourne Stroke Incidence Study. Results: Among 306,631 people, there were 645 incident strokes managed in hospital. When eligible patients were extrapolated to the Australian population, for every 1,000 cases, 46 (95% CI 17–69) could have been saved from death or dependency with stroke unit management, 6 (95% CI 1–11) by using aspirin, 11 (95% CI 5–17) or 10 (95% CI 3–16) by using tPA at 3 and 6 h, respectively. Conclusions: Although tPA is the most potent intervention, management in stroke units has the greatest population benefit and should be a priority.