Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy

Abstract

The Canadian Stroke Best Practice Consensus Statement: Secondary Stroke Prevention during Pregnancy, is the first of a two-part series devoted to stroke in pregnancy. This document focuses on unique aspects of secondary stroke prevention in a woman with a prior history of stroke or transient ischemic attack who is, or is planning to become, pregnant. Although stroke is relatively rare in this cohort, several aspects of pregnancy can increase stroke risk during or immediately after pregnancy. The rationale for the development of this consensus statement is based on the premise that stroke in this group requires a specifically-tailored management approach. No other broad-based, stroke-specific guidelines or consensus statements exist currently. Underpinning the development of this document was the concept that maternal health is vital for fetal wellbeing; therefore, management decisions should be based on the confluence of two clinical considerations: (a) decisions that would be made if the patient was not pregnant and (b) decisions that would be made if the patient had not had a stroke. While empirical research in this area is limited, this consensus document is based on the best available literature and guided by expert consensus. Issues addressed in this document include general management considerations for secondary stroke prevention, the use of antithrombotics, blood pressure management, lipid management, diabetes care, and management for specific ischemic stroke etiologies in pregnancy. The focus is on maternal and fetal health while minimizing risks of a recurrent stroke, through counseling, monitoring, and the safety of select pharmacotherapy. These statements are appropriate for health care professionals across all disciplines.

Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy

“…Refer to Secondary Prevention of Stroke during Pregnancy module for detailed information on stroke prevention management and pharmacotherapy. 7 Poststroke antenatal obstetric considerations for women with a stroke in pregnancy…”

The Possible Effect of Oxytocin in Postpartum Recovery From a Stroke: A Case Report

“…We were surprised that this patient had not previously undergone a medical or neurologic assessment for her history of presumed transient ischemic attacks. According to the recent guidelines, prepregnancy counseling and secondary stroke prevention could have been valuable in this case [11]. Furthermore, although several studies have reported the characteristics of pregnancyrelated stroke, information on rehabilitation strategies for stroke during pregnancy is lacking.…”

Ontario Neurodegenerative Disease Research Initiative (ONDRI): Structural MRI Methods and Outcome Measures

“…In Canada, ~62,000 people are treated for stroke and transient ischemic attack. In a series of publications, the Heart and Stroke Foundation Canadian Best Practice Committees have been developing various evidence-based recommendations to address issues regarding: telestroke technologies ( 95 ); managing transitions of care following stroke ( 96 ); mood, cognition, and fatigue following stroke ( 97 ); hyperacute stroke care ( 98 ); secondary prevention of stroke ( 99 ); and stroke during pregnancy ( 100 , 101 ).…”