Brain Sciences


UCL-led trial to improve outcomes for stroke survivors

26 March 2021

Led by UCL and funded by the British Heart Foundation, the OPTIMAS (OPtimal TIMing of Anticoagulation after Stroke) trial is seeking to improve medical care for future stroke survivors all over the world.



Every year, around 30,000 people in the UK suffer an ischaemic stroke (blockage of a brain blood vessel by a clot) due to an abnormal heart rhythm known as atrial fibrillation (AF).

While new anticoagulant (blood thinning) treatments are available, medical professionals still don’t know when it’s best to prescribe them to prevent a further stroke. There is concern about bleeding in the brain if the anticoagulants are given early, but each day of waiting runs the risk of more blood clots going to the brain from the heart to cause another stroke.

Taking place in over 70 hospitals across the whole of the UK, and working together with researchers, clinical teams and patients, the OPTIMAS trial is looking to answer the crucially important question of anticoagulant timing after acute stroke in people with AF. 

Professor David Werring (UCL Queen Square Institute of Neurology) said: “OPTIMAS aims to obtain new data on early direct oral anticoagulants (DOAC) treatment to change standard practice in the acute stroke care pathway, reduce hospital stays, and improve quality of life for patients with AF and acute ischaemic stroke.”

“Newer DOACs are increasingly used in modern clinical practice, because we know that in the long term they are highly effective to prevent strokes associated with atrial fibrillation. More recent studies suggest that early DOAC use is associated with a low risk of intracranial bleeding – while delays increase the risk of a further stroke. So, starting DOAC medication early might be safe and effective. But a randomised controlled trial comparing early and delayed treatment is needed to answer this important question.” 

OPTIMAS was recently mentioned as a case study in a UK government report on the future of clinical research delivery, published on 23 March 2021.

“With adaptations to our protocol and the hard work of our UCL study team and investigators around the UK, OPTIMAS has continued to recruit throughout the COVID-19 pandemic.

“It has been highlighted as an excellent example of what can be achieved with collaboration right across the UK within the NHS via the National Institute for Health Research (NIHR) Clinical Research Network. This government report recognises the fantastic resilience and teamwork of NHS research staff, and proves that research to prevent life-threatening and potentially disabling diseases like stroke can still be successfully delivered even during the challenging setting of the COVID-19 pandemic,” added Professor Werring.