• Amanda K Gilligan, Amanda G Thrift, Jonathan W Sturm, Helen M Dewey, Richard A L Macdonell, and Geoffrey A Donnan.
• Department of Neurology, Austin and Repatriation Medical Center, Heidelberg, Australia.
• Cerebrovasc. Dis. 2005 Jan 1; 20 (4): 239-44.

BackgroundAlthough 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.MethodsEligibility 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.ResultsAmong 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.ConclusionsAlthough tPA is the most potent intervention, management in stroke units has the greatest population benefit and should be a priority.

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