AANS Neurosurgeon | Volume 29, Number 1, 2020


A SMARTer Way to Discover New Stroke Treatments

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A sequential multiple assignment randomized (SMART) trial allows researchers to test two hypotheses at once. The new trial method is being used in clinical trials across the industry. “SMART trials allow you to get to two questions at once and can potentially be more efficient,” says William Meurer, MD, associate professor of emergency medicine and neurology at Michigan Medicine and a member of the Michigan Center for Integrative Research in Critical Care. “You may find answers you wouldn’t normally find using a normal trial design.” Meurer is the lead author on the study that investigated if the trial design could be used specifically to study stroke treatment. “In stroke, we are often treating the patient with a tissue plasminogen activator drug upfront to dissolve a blood clot in the brain,” Meurer says. “Sometimes, that blood clot doesn’t dissolve. What do you do next?” This question led the research team to a SMART trial design, says Meurer, also a member of the U-M Institute for Healthcare Policy and Innovation.

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