A clinical trial to improve the treatment of people who have a stroke in their sleep

Tenecteplase in Wake-up Ischaemic Stroke Trial (TWIST)

Most strokes are caused by a blood clot in an artery that feeds the brain – called ischaemic stroke. People who have an ischaemic stroke will usually be given clot-busting medicine to restore blood flow to the brain. If this is done within 4.5 hours it can improve their long-term outlook and recovery. However, about one fifth of strokes occur when someone is asleep and then the person wakes up with symptoms. People who have these ‘wake-up strokes’ are not offered clot-busting treatment because it’s not known what time the stroke took place and whether the treatment would be effective. This international clinical study, which is taking place in Norway, the UK and other locations, will trial a different clot-busting medicine, tenecteplase, in people with wake-up stroke. Patients will be randomly assigned in hospital to receive usual care, or usual care plus tenecteplase. When they are discharged from hospital each person’s recovery will be assessed. Then three months later, the patient or their relative will be contacted and asked about their recovery, their memory, how they feel and whether they require any additional help. Around 200 wake-up stroke patients admitted to 10 hospitals will be involved in the UK arm of the trial. It is hoped it will improve the long-term outcome for people who have wake-up strokes.