INTERACT3 results: care bundle improves outcomes in intracerebral hemorrhage

Craig Anderson, PhD, from the The George Institute for Global Health, University of New South Wales, Sydney, Australia, discusses INTERACT3 (NCT03209258), the largest clinical trial ever conducted in patients with intracerebral hemorrhage (ICH), assessing the efficacy of a goal directed care bundle. What makes this trial unique is its use of a stepped-wedge, cluster-randomized clinical trial design on an international scale, which involved randomizing hospitals rather than individual patients. Over 120 hospitals and 7100 patients participated across 9 low-middle income countries and one high-income country. The care bundle protocol encompassed early intensive blood pressure lowering (≤140 mmHg), rapid reversal of hyperglycaemia, fever control, and rapid reversal of anticoagulation. The primary endpoint, assessed at six months by the modified Rankin scale, showed significant improvements in patient outcomes in the care bundle group, compared to usual care. Reduced mortality, improved quality of life, and shorter hospital stays were also noted. Significantly, INTERACT3 is the first-ever clinical trial to show a beneficial treatment of ICH and has generated high level evidence for an active management approach involving protocol-driven care. This interview took place at The European Stroke Organisation Conference 2023 in Munich, Germany.

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