Emergency physician Dr Andy Lim’s study identifies superior treatment for minor strokes

Dr Andy Lim, emergency physician

Dr Andy Lim, an emergency physician at Monash Health, has achieved a significant milestone in his career with a recent publication in JAMA Network Open. His article analyses the use of different medications in patients with minor strokes. This rigorous study involved collaborating with world experts and utilising sizeable clinical trial data. 

Dr Lim began his tenure at Monash Health as an emergency physician. In 2020, his interest in research and innovation was recognised and supported when he was awarded a Monash Health Emerging Researcher Fellowship, supporting his early work on improving stroke diagnosis and treatment.

As his career progressed and he worked towards a PhD, he focused on investigating transient ischemic attack (TIA) treatment, advocating for immediate CT scans to reduce stroke risks. He also contributed to standardising stroke protocols to enhance patient safety and consistency in care.

Transient ischemic attack (TIA), often referred to as a ‘mini-stroke’, is a temporary interruption of blood flow to the brain, usually caused by a blood clot. The symptoms of a TIA are similar to those of a stroke but typically resolve within a short time without causing permanent damage. However, TIAs are considered warning signs of a possible impending stroke and should be taken seriously. 

Dr Lim’s recent publication in JAMA Network Open further illustrates his evolution to becoming an independent researcher. 

Over two years, Dr Lim, a PhD candidate under the supervision of neurologists and stroke specialists Professors Thanh G. Phan and Henry Ma, gathered a significant amount of unpublished clinical trial data for the study. 

The study is a meta-analysis of five clinical trials encompassing an impressive 28,148 patients. It aimed to compare the efficacy of dual antiplatelet therapies tailored explicitly for minor, non-disabling acute ischemic strokes.  

Platelets are small blood cell fragments crucial for blood clotting. They gather at injury sites to form plugs, stopping bleeding, but can also cause clots leading to strokes or heart attacks.  

Antiplatelets are medications used to prevent blood clots. 

A minor ischemic stroke occurs when a blood vessel supplying blood to the brain is obstructed or blocked, comprising a significant proportion of stroke admissions. 

Dr Lim’s research focused on comparing the clinical trial data on dual antiplatelet therapies, which involve using two different medications simultaneously to reduce the risk of further clot formation in blood vessels within 24 hours of stroke onset. 

He explained, “The idea behind using two medications is that they might work better together to prevent blood clots than just using one alone.” 

The results of Dr Lim’s analysis indicated that the combination of aspirin and ticagrelor is the most effective dual antiplatelet therapy for minor strokes.  

Aspirin is a commonly used antiplatelet medication that helps prevent blood clot formation by inhibiting the activity of platelets, which are small blood cells involved in clotting. 

Ticagrelor is another antiplatelet medication that works by blocking a specific receptor on platelets, thereby preventing them from sticking together to form blood clots. 

“Our findings showed a 94% likelihood that the combination of medications (aspirin and ticagrelor) is superior for treating minor strokes and a 60% likelihood of being superior for high-risk TIAs,” Dr. Lim stated.  

These findings have significant implications for clinical practice. They show that aspirin and ticagrelor may be the best choice for preventing recurrent strokes within a critical 90-day window in patients with minor strokes. 

By focusing on minor stroke groups, Dr Lim’s research challenges the assumption of uniform responses to antiplatelet therapy between minor stroke and TIA, emphasising the need for nuanced therapeutic decisions guided by robust evidence. 

This research represents a successful cross-department collaboration between the Stroke Unit in the Neurology Department and the Emergency Department (ED) at Monash Health.  

Dr Lim explained, “With strokes being so common in emergency departments, my experience in both emergency and stroke medicine really helps me connect the dots in patient care and improve our treatment protocols.”  

He continued: “Research really helps us bridge the gap between different areas of medicine. By developing evidence-based protocols, we can ensure patients get the right care quickly. This approach not only reduces variability in practice but also prepares emergency departments to be proactive in stroke management.” 

“It’s all about working together across departments, tailoring treatments, and making sure every patient gets the best, most personalised care possible,” said Dr Lim. 

His PhD work is progressing well, reflecting his dedication and the supportive research environment here at Monash Health. He recently presented his work at the renowned European Stroke Organisation Conference in Basel, Switzerland.    

“Presenting at an international conference is a great opportunity to share our findings and engage with global experts,” said Dr Lim. 

His journey exemplifies how dedicated research efforts can drive medical advancements and improve healthcare delivery. 

Dr Lim concluded, “Research opens up exciting opportunities to push the boundaries in medicine. It enhances our understanding and treatment of conditions and significantly contributes to professional growth. The support from Monash Health, my colleagues and the Emerging Researcher Fellowship has been instrumental, allowing me to collaborate with experts and make meaningful contributions that positively impact patient outcomes and the broader healthcare community.” 

Approved by Angus Henderson, General Manager, Research Strategy