Fast Assessment of Stroke and Transient Ischemic Attack to Prevent Early Recurrence (FASTER)
Current management of patients with TIA (transient ischemic attack) or minor stroke includes the prompt investigation and treatment in the days and weeks after the event. However, new evidence shows patients are at the highest risk of stroke in the first few days after the TIA, with 50% of strokes which happen in the three months following TIA occurring within 48-72 hours. To date, there is no evidence to guide physicians on how to safely reduce this risk.
The FASTER trial is focusing on the initial period of high risk, starting patients on stroke prevention treatments in the hours following a TIA or minor stroke. The drugs to be tested have been shown to be effective in the similar setting of cardiology, reducing recurrent cardiac events in patients with unstable angina when commenced with the same speed after an event.
All patients will be on aspirin. The trial will see if adding another drug, clopidogrel, has an additional benefit in reducing the number of strokes after TIA or minor stroke within three months of TIA or minor stroke. It will also look if the very early introduction of simvastatin, a cholesterol lowering therapy, reduces stroke after TIA or minor stroke, both by itself and in addition to clopidogrel. The final aim of the trial is to ensure that these treatments are safe to be used in this population of patients.
|Transient Ischemic Attack Stroke||Drug: Aspirin Drug: Clopidogrel Drug: Simvastatin||Phase 2 Phase 3|
|Study Design:||Allocation: Randomized
Intervention Model: Factorial Assignment
Primary Purpose: Prevention
|Official Title:||Fast Assessment of Stroke and Transient Ischemic Attack to Prevent Early Recurrence (FASTER)|
- Any stroke at 90 days
- Stroke severity
- Composite of stroke
- Myocardial infarction
- Vascular death at 90 days
|Study Start Date:||May 2003|
|Study Completion Date:||February 2007|
The Fast Assessment of Stroke and Transient ischemic attack to prevent Early Recurrence (FASTER) is a randomized clinical trial designed to investigate the effect of hyper-acute initiation of stroke prevention treatments in patients with a minor stroke or transient ischemic attack (TIA).
This group of individuals has been recognized as being at high risk of recurrent events. Johnston et al. (2000) were the first to suggest that the risk of stroke after TIA was front-loaded in the first few days. This has been confirmed elsewhere with Lovett et al. (2003) having shown in the Oxfordshire Community Stroke Project that the 7-day risk of recurrent stroke was 8.6%, and a 30-day risk of 12.0%. These findings are similarly found in the Oxford Vascular Study; 8.0% and 11.5% respectively for a recurrent event (Coull et al., 2004). The NASCET (North American Symptomatic Carotid Endarterectomy Trial) study also supports the finding of high risk of early recurrent stroke. 8.5% of patients with a hemispheric TIA suffered a recurrent stroke within one week rising to 20% at 90-days (Eliasziw et al., 2004). This data suggest that patients with carotid stenosis are at the highest risk of early recurrent stoke.
Only one in four patients with acute ischemic stroke presenting within three hours of symptom onset are being treated with t-PA (Barber et al., 2001). The most common reason for exclusion from treatment is that a patient's deficit will be too mild for treatment or will have completely resolved thereby not meriting the risks of treatment with tPA. These are the patients that have a higher risk of early recurrence. The clinical imperative is to identify hyper-acute treatment strategies to minimize that risk.
FASTER is a double blind, randomized controlled trial with a 2x2 factorial design with patients followed for 90-days. Patients will be randomized within 24 hours of symptom onset to one of four possible treatment arms:
- Aspirin and Clopidogrel
- Aspirin and Simvastatin
- Aspirin and Clopidogrel and Simvastatin
A. A rapid commencement of clopidogrel plus aspirin within 24 hours of acute TIA or minor stroke is more effective than aspirin in reducing the 90-day risk of stroke by an absolute difference of 2%.
B. A rapid commencement of simvastatin plus aspirin within 24 hours of acute TIA or minor stroke is more effective than aspirin in reducing the 90-day risk of stroke by an absolute difference of 2%.
C. A rapid commencement of clopidogrel plus aspirin plus simvastatin within 24 hours of acute TIA or minor stroke is more effective than aspirin alone in reducing the 90-day risk of stroke by an absolute difference of 4%.
D. The incidence of adverse events is not different among treatment groups.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00109382
|United States, Pennsylvania|
|University of Pennsylvania|
|Philadelphia, Pennsylvania, United States, 19104|
|Foothills Medical Centre|
|Calgary, Alberta, Canada, T2N 2T9|
|Universtiy of Alberta Walter MacKenzie Health Sciences Centre|
|Edmonton, Alberta, Canada, T6G 2B7|
|University of Lethbridge Hospital|
|Lethbridge, Alberta, Canada, T1J 0N9|
|Canada, British Columbia|
|Vancouver General Hospital|
|Vancouver, British Columbia, Canada, V5Z 3J5|
|St. Paul's Hospital|
|Vancouver, British Columbia, Canada, V6Z 1Y6|
|Centre for Stroke Research|
|Victoria, British Columbia, Canada, V8R 4R4|
|Canada, New Brunswick|
|St. John Regional Hospital|
|Saint John, New Brunswick, Canada, E2L 4L2|
|Canada, Nova Scotia|
|Queen Elizabeth ll Health Sciences Centre|
|Halifax, Nova Scotia, Canada, B3H 3A7|
|London Health Sciences Centre - University Hospital|
|London, Ontario, Canada, N5A 5A5|
|Trillium Health Centre|
|Mississauga, Ontario, Canada, L5B 4A2|
|Ottawa, Ontario, Canada, K1H 8L6|
|Sunnybrook Women's Health Centrre|
|Toronto, Ontario, Canada, M4N 3M5|
|St. Mike's Hospital|
|Toronto, Ontario, Canada, M5C 1R6|
|Toronto Western Hospital -University Health Network|
|Toronto, Ontario, Canada, M5T 2S8|
|Chicoutimi, Quebec, Canada, G7H 6B9|
|Hopital Charles LeMoyne|
|Greenfield Park, Quebec, Canada, J4V 2H1|
|Hopital Notre-Dame du CHUM|
|Montreal, Quebec, Canada, H2L 4M1|
|Principal Investigator:||Alastair M Buchan||Dept of Clinical Neurosciences, University of Calgary|
|Study Director:||James Kennedy||Nuffield Dept of Clinical Medicine, University of Oxford|