SECONDARY PREVENTION OF ISCHEMIC STROKE: INTERNATIONAL RECOMMENDATIONS AND CLINICAL PRACTICE

2015 ◽  
Vol 19 (2) ◽  
pp. 4 ◽  
Author(s):  
V. A. Parfenov ◽  
S. V. Verbitskaya
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Secondary Prevention

scholarly journals Etiologic Workup in Cases of Cryptogenic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1419-1427 ◽  
Author(s):  
Naoimh E. McMahon ◽  
Munirah Bangee ◽  
Valerio Benedetto ◽  
Emma P. Bray ◽  
Rachel F. Georgiou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Secondary Prevention ◽  
Acute Ischemic Stroke ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cryptogenic Stroke ◽  
Unique Identifier ◽  
Missed Opportunities ◽  
Consensus Statements

Background and Purpose— Identifying the etiology of acute ischemic stroke is essential for effective secondary prevention. However, in at least one third of ischemic strokes, existing investigative protocols fail to determine the underlying cause. Establishing etiology is complicated by variation in clinical practice, often reflecting preferences of treating clinicians and variable availability of investigative techniques. In this review, we systematically assess the extent to which there exists consensus, disagreement, and gaps in clinical practice recommendations on etiologic workup in acute ischemic stroke. Methods— We identified clinical practice guidelines/consensus statements through searches of 4 electronic databases and hand-searching of websites/reference lists. Two reviewers independently assessed reports for eligibility. We extracted data on report characteristics and recommendations relating to etiologic workup in acute ischemic stroke and in cases of cryptogenic stroke. Quality was assessed using the AGREE II tool (Appraisal of Guidelines for Research & Evaluation). Recommendations were synthesized according to a published algorithm for diagnostic evaluation in cryptogenic stroke. Results— We retrieved 16 clinical practice guidelines and 7 consensus statements addressing acute stroke management (n=12), atrial fibrillation (n=5), imaging (n=5), and secondary prevention (n=1). Five reports were of overall high quality. For all patients, guidelines recommended routine brain imaging, noninvasive vascular imaging, a 12-lead ECG, and routine blood tests/laboratory investigations. Additionally, ECG monitoring (>24 hours) was recommended for patients with suspected embolic stroke and echocardiography for patients with suspected cardiac source. Three reports recommended investigations for rarer causes of stroke. None of the reports provided guidance on the extent of investigation needed before classifying a stroke as cryptogenic. Conclusions— While consensus exists surrounding standard etiologic workup, there is little agreement on more advanced investigations for rarer causes of acute ischemic stroke. This gap in guidance, and in the underpinning evidence, demonstrates missed opportunities to better understand and protect against ongoing stroke risk. Registration— URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42019127822.

scholarly journals Ischemic Stroke and Secondary Prevention in Clinical Practice

Stroke ◽  
2010 ◽  
Vol 41 (7) ◽  
pp. 1338-1342 ◽  
Author(s):  
Signild Åsberg ◽  
Karin M. Henriksson ◽  
Bahman Farahmand ◽  
Kjell Asplund ◽  
Bo Norrving ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Secondary Prevention

ANTIPLATELET AGENTS IN THE TREATMENT AND SECONDARY PREVENTION OF PEDIATRIC ARTERIAL ISCHEMIC STROKE: THE STATE OF THE PROBLEM

2021 ◽  
Vol 100 (5) ◽  
pp. 151-159
Author(s):  
I.B. Komarova ◽  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Secondary Prevention ◽  
Acetylsalicylic Acid ◽  
Antiplatelet Agents ◽  
First Year ◽  
Evidence Based ◽  
Arterial Ischemic Stroke ◽  
Level Of Evidence ◽  
Low Level

Arterial ischemic stroke (AIS) in children is a potentially disabling disease with cumulative rates of relapse in the first year of 12–16%, necessitating secondary prevention of the disease. Both in adults and in pediatric clinical practice, acetylsalicylic acid is most commonly used, much less often – clopidogrel. However, the validity of the use of antiplatelet agents in children with ischemic stroke is still controversial, due to the low level of evidence-based studies and the paucity of publications. The article analyzes and summarizes data on the possibilities and limitations of the use of antiplatelet agents for secondary prevention of AIS in children.

Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery

2020 ◽  
Author(s):  
Lungwani Muungo
Keyword(s):  
Economic Growth ◽  
Developing Countries ◽  
Clinical Practice ◽  
Cardiovascular Diseases ◽  
Secondary Prevention ◽  
Health Authorities ◽  
Overwhelming Evidence ◽  
Core Components ◽  
Interventional Therapies ◽  
Limited Period

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major healthcare and socio-economic burden both in western and developing countries, in which this burden is increasing in closecorrelation to economic growth. Health authorities and the general population have started to recognize that the fightagainst these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestylechanges and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives includingcardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorlyimplemented in clinical practice, often only on selected populations and over a limited period of time. The developmentof systematic and full comprehensive preventive programmes is warranted, integrated in the organization ofnational health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity.

Racial differences in persistence to secondary prevention medication regimens after ischemic stroke

2021 ◽  
pp. 1-13
Author(s):  
Orla C. Sheehan ◽  
Mandip S. Dhamoon ◽  
Janet Prvu Bettger ◽  
Jin Huang ◽  
Chelsea Liu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Racial Differences

Evaluation on the compliance with secondary prevention and influence factors of ischemic stroke in Hainan province, China

Vascular ◽  
2013 ◽  
Vol 22 (3) ◽  
pp. 181-187 ◽  
Author(s):  
Qingjie Su ◽  
Kunxiong Yuan ◽  
Faqing Long ◽  
Zhongqin Wan ◽  
Chaoyun Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Health Education ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Influence Factors ◽  
Significant Risk ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Logistic Regression Models ◽  
Prevention Therapy

Survivors of ischemic stroke are still at a significant risk for recurrence. Numerous effective strategies for the secondary prevention of ischemic stroke have now been established; however, these guidelines are not widely known. In this retrospective, a multicenter study was conducted from January 2011 to February 2012 in 10 general hospitals, which included 1300 elderly patients who had previously been diagnosed with ischemic stroke and re-admitted to hospitals. Logistic regression models were fitted to determine the relationship between compliance with secondary prevention therapy and each variable of interest. The treatment rates of antihypertensive, antiplatelet and lipid-lowering therapy were only 56.3%, 48.9% and 19.6%, respectively. Multivariate analysis presented that cardiovascular risk factors would motivate patients with hypertension and hyperlipidemia to receive corresponding treatments. However, it is worth noting that they did not influence the use of antiplatelet therapy. In addition, high education, health education and insurance promote the use of secondary prevention in patients. In conclusion, the importance of antiplatelet therapy should not be ignored any more. Besides, health education will raise patients’ attention to ischemic stroke.

2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

2017 ◽  
Vol 12 (3) ◽  
pp. 302-320 ◽  
Author(s):  
Yongjun Wang ◽  
Ming Liu ◽  
Chuanqiang Pu
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Evidence Based ◽  
Cerebrovascular Disorder ◽  
Level Of Evidence ◽  
Vascular Stenosis ◽  
Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

scholarly journals Multifactorial Background for a Low Biological Response to Antiplatelet Agents Used in Stroke Prevention

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 59
Author(s):  
Adam Wiśniewski
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Negative Impact ◽  
Platelet Reactivity ◽  
Antiplatelet Agent ◽  
Biological Response ◽  
Antiplatelet Agents ◽  
Platelet Inhibition ◽  
High Risk Group

Effective platelet inhibition is the main goal of the antiplatelet therapy recommended as a standard treatment in the secondary prevention of non-embolic ischemic stroke. Acetylsalicylic acid (aspirin) and clopidogrel are commonly used for this purpose worldwide. A low biological response to antiplatelet agents is a phenomenon that significantly reduces the therapeutic and protective properties of the therapy. The mechanisms leading to high on-treatment platelet reactivity are still unclear and remain multifactorial. The aim of the current review is to establish the background of resistance to antiplatelet agents commonly used in the secondary prevention of ischemic stroke and to explain the possible mechanisms. The most important factors influencing the incidence of a low biological response were demonstrated. The similarities and the differences in resistance to both drugs are emphasized, which may facilitate the selection of the appropriate antiplatelet agent in relation to specific clinical conditions and comorbidities. Despite the lack of indications for the routine assessment of platelet reactivity in stroke subjects, this should be performed in selected patients from the high-risk group. Increasing the detectability of low antiaggregant responders, in light of its negative impact on the prognosis and clinical outcomes, can contribute to a more individualized approach and modification of the antiplatelet therapy to maximize the therapeutic effect in the secondary prevention of stroke.

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