Current Strategies of Secondary Prevention After a Cerebrovascular Event

Abstract

on behalf of the Vienna Stroke Study Group Background and Purpose-Oral anticoagulation (OAC) and antiplatelet drugs are effective in the secondary prevention of ischemic cerebrovascular events. Only few data exist about the factors influencing the choice of a specific therapy for secondary prevention in patients with a recent stroke or transient ischemic attack (TIA). Methods-Within a cross-sectional study, nested in a cohort we identified 931 patients with a recent ischemic stroke or TIA who were discharged with OAC or with one of the antiplatelet medications aspirin, clopidogrel, or the combination of aspirin and extended-release dipyridamole. By means of multivariate logistic regression analysis, we determined the influence of several clinical variables on the decision between OAC and overall antiplatelet therapy as well as on the decision between different antiplatelet therapies. Results-A cardioembolic etiology of the index event and atrial fibrillation were independently associated with the use of OAC. Age was inversely associated with the use of OAC. Different estimations of contraindications to OAC were the main reason for the considerable variability among the participating centers. The most important factor promoting the use of clopidogrel was therapy with aspirin before the index event. Patients with large-or small-vessel disease received clopidogrel more often than those with an event of undetermined etiology. We found an extremely high interhospital variability for the use of the combination of aspirin with extended-release dipyridamole. Conclusions-Current

Routine echocardiography in the management of stroke and transient ischaemic attack: a systematic review and economic evaluation

“…Two studies 61,117 reported data for mitral valve regurgitation using TTEf and one study 119 reported data for mitral valve regurgitation using TTEh; eight studies 61,107,120,125,132,142,152,156 reported data for left atrial appendage thrombi using fundamental imaging and one study 120 used harmonic imaging. Left atrial thrombi data were reported in three studies 145,148,156 using TTEf and three studies 126,136,141 using TTEh; one study 138 reported data for right atrial thrombi using TTEf; three studies 122,124,130 reported TTEh and TTEf data for left ventricular thrombi; three studies 114,132,142 reported TTEf data for spontaneous echo contrast (SEC); four studies 118,152,154,155 reported TTEf data for left atrial SEC and one study 136 reported TTEh data for left atrial SEC; one study 154 reported data for left ventricular SEC with TTEf; two studies reported TTEf and TTEh data for left ventricular aneurysm; 108,135 two studies reported TTEh data for cardiac vegetations 149,153 and one study 149 reported TTEf data; one study 129 reported TTEf data for aortic valve stenosis; one study 61 reported TTEf data for mitral valve stenosis; two studies 111,147 reported TTEh data for mitral valve prolapse; and one study 148 reported TTEf data for atrial myxoma.…”

“…Most studies (n = 32 [107][108][109]111,112,[114][115][116][117]121,123,124,127,131,[133][134][135][136][137][138][139][140][142][143][144]147,148,[150][151][152][153]156 ) did not report how participants were selected for inclusion into the study; 12 studies 61,110,[118][119][120]122,125,126,129,145,154,155 provided details on patient selection and seven 113,128,130,132,141,146,149 reported only brief details.…”

“…Most studies 61,139,140,[142][143][144][145][146][147][148][149][150][151][152][153][154][155][156] used a reference standard that was considered to classify the target condition correctly, and most studies used TOE as the reference standard, that is, the 'gold standard'. TOE is considered the gold standard for assessing PFO but the test is acknowledged to be imperfect, although it is assumed to be superior to the index test TTE.…”

“…Most studies [109][110][111][112][113][114][115][116]120,121,[123][124][125][127][128][129][130][131][132][133][134][135][136][137][139][140][141][142][143][144][146][147][148][149][150][151][152][153]156 reported the time taken between administering the reference test and the index test, and this was judged to be reasonably short enough to ensure that the target condition did not change. Some studies 61,107,108,117,118,119,122,126,138,145,154,155 did not report the time taken between tests for the assessment of PFO, but these studies were not downgraded on quality as PFO will not be affected during the study period.…”

“…The majority of studies 108-115,120,124-126,128,129,133,136-139,141-144, 146,147,149-152,154,156 provided sufficient details to permit replication of the reference and index tests. However, many studies did not report the procedures used, 61,107,110,116,118,121,122,124,127,130,131,135,140,145,148,153,154 with some 115,117,119,123,132,134,147,154 reporting only brief details.…”