Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack

Furie, Karen L.; Kasner, Scott E.; Adams, Robert J.; Albers, Gregory W.; Bush, Ruth L.; Fagan, Susan C.; Halperin, Jonathan L.; Johnston, S. Claiborne; Katzan, Irene; Kernan, Walter N.; Mitchell, Pamela H.; Ovbiagele, Bruce; Yu, Amy Y.X.; Sacco, Ralph L.; Schwamm, Lee H.; Wassertheil‐Smoller, Sylvia; Turan, Tanya N.; Wentworth, Deidre

doi:10.1161/str.0b013e3181f7d043

Cited by 1,400 publications

(645 citation statements)

References 551 publications

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“…1,5 Overall, adherence to prescribed medication was very good and associated with attainment of optimal therapy status. These results support the effectiveness of a specialized SPC in managing this high-risk population, although we could not show a direct effect on vascular outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…We based BP targets were based on recommendations from best-practice stroke guidelines. 1,5 For nondiabetics, target was <140/90 mmHg; for diabetics, <130/80 mmHg. We also collected information about types of antihypertensives used.…”

Section: Hypertensionmentioning

confidence: 99%

“…2 Reducing the rate of recurrent stroke requires identifying and controlling modifiable risk factors in the early poststroke/transient ischemic attack (TIA) period and developing appropriate preventive strategies. 1,[3][4][5][6] The identification and control of modifiable vascular risk factors (MRFs) is one of the main goals of stroke prevention clinics (SPCs) in addition to appropriate use of antithrombotics and selective surgical interventions as suggested by current practice guidelines. 1,6,7 Unfortunately, a relatively high proportion of patients fail to achieve the recommended therapeutic objectives.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to Guidelines: Experience of a Canadian Stroke Prevention Clinic

Alsalti

Vieira

Côté

2014

Can. J. Neurol. Sci.

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Background: Few studies have assessed the performance of stroke prevention clinics. In particular, limited information exists on patient compliance, achievement of therapeutic targets, and related occurrence of vascular events. Methods: We compared our clinical practice to recommendations from published guidelines in newly referred patients for transient ischemic attack (TIA) or ischemic stroke between 2008 and 2010. We monitored our cohort for at least 1 year and assessed for adequacy of vascular risk factor management, drug adherence, and occurrence of nonlethal vascular outcomes. Results: Of 408 patients, 57.8% had a stroke and 42.2% a TIA. The mean age was 68 ± 13 years, and 52% male. Average follow-up was 15.8 months. During follow-up, 253 patients (70.3%) completely achieved their blood pressure target, 151 (45.5%) achieved their low-density lipoprotein (LDL) cholesterol target, and 407 (99.8%) were on antithrombotics. Eighty-nine patients (21.8%) attained optimal therapy status, defined as reaching targets for LDL cholesterol, blood pressure, and antithrombotic use. Adherence to drug therapy was associated with attainment of optimal therapy status (p = 0.01). Diabetes was associated with lower probability of attaining optimal therapy status (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.20-0.66) and blood pressure targets (OR, 0.09; 95% CI, 0.05-0.17). During follow-up, 52 (12.7%) patients had a nonlethal vascular event. Conclusion: Our study shows good attainment of therapeutic goals associated with adherence to drug therapy. However, optimal therapy status and blood pressure targets were more difficult to attain in patients with diabetes; therefore, more intensive preventive efforts may be required for these individuals.

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Section: Resultsmentioning

confidence: 99%

Section: Hypertensionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adherence to Guidelines: Experience of a Canadian Stroke Prevention Clinic

Alsalti

Vieira

Côté

2014

Can. J. Neurol. Sci.

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“…For the secondary prevention of vascular occlusive disease, antiplatelet therapy with either acetylsalicylic acid (ASA) or clopidogrel alone or a combination of both is recommended (Diener et al, 2007;Furie et al, 2011;Hirsch et al, 2006;Smith et al, 2006). Clopidogrel, a thienopyridine derivative, inhibits platelet function by selective and irreversible binding to their ADP-dependent receptor P2Y12.…”

Section: Introductionmentioning

confidence: 99%

Acetylsalicylic Acid, but Not Clopidogrel, Inhibits Therapeutically Induced Cerebral Arteriogenesis in the Hypoperfused Rat Brain

Duelsner

Gatzke

Gläser

et al. 2011

J Cereb Blood Flow Metab

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This study investigated the effects of acetylsalicylic acid (ASA) and clopidogrel, standardly used in the secondary prevention of vascular occlusions, on cerebral arteriogenesis in vivo and in vitro. Cerebral hypoperfusion was induced by three-vessel occlusion (3-VO) in rats, which subsequently received vehicle, ASA (6.34 mg/kg), or clopidogrel (10 mg/kg). Granulocyte colony-stimulating factor (G-CSF), which enhanced monocyte migration in an additional cell culture model, augmented cerebrovascular arteriogenesis in subgroups (40 lg/kg). Cerebrovascular reactivity and vessel diameters were assessed at 7 and 21 days. Cerebrovascular reserve capacity was completely abolished after 3-VO and remained severely compromised after 7 (À14 ± 14%) and 21 (À5 ± 11%) days in the ASA groups in comparison with controls (4 ± 5% and 10 ± 10%) and clopidogrel (4 ± 13% and 10 ± 8%). It was still significantly decreased when ASA was combined with G-CSF (1 ± 4%) compared with G-CSF alone (20 ± 8%). Posterior cerebral artery diameters confirmed these data. Monocyte migration into the vessel wall, improved by G-CSF, was significantly reduced by ASA. Acetylsalicylic acid, but not clopidogrel, inhibits therapeutically augmented cerebral arteriogenesis.

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“…1 The risk of recurrent stroke after TIA is 5%-20% within 90 days, with about half of all recurrent strokes occurring in the first two days following initial symptom onset. [1][2][3][4] Early assessment in a dedicated neurovascular clinic and immediate initiation of medical and surgical therapy have been shown to reduce the risk of major stroke after TIA by up to 80%. 5 Patients with TIA often present to the emergency department (ED) for initial evaluation.…”

Section: Introductionmentioning

confidence: 99%

Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

Hosier

Phillips

Doucette

et al. 2016

CJEM

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Objectives: 1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic. Methods: Retrospective chart review of all patients discharged from EDs in our district from January 1, 2011 to December 31, 2012 with a diagnosis of TIA. Cox proportional hazards models, Kaplan-Meier survival curve, and propensity matched analyses were used to evaluate 90-day mortality and readmission. Results: Of the 686 patients seen in the ED for TIA, 88.3% received computed tomography (CT) scanning, 86.3% received an electrocardiogram (ECG), 35% received vascular imaging within 24 hours of triage, 36% were seen in a neurovascular clinic, and 4.2% experienced stroke, myocardial infarction, or vascular death within 90 days. Rates of antithrombotic use were increased in patients seen in a neurovascular clinic compared to those who were not (94% v. 86.3%, p < 0.0001). After adjustment for age, sex, vascular disease risk factors, and stroke symptoms, the risk of readmission for stroke, myocardial infarction, or vascular death was lower for those seen in a neurovascular clinic compared to those who were not (adjusted hazard ratio 0.28; 95% confidence interval 0.08-0.99, p = 0.048). Conclusion: The majority of patients in our study were treated with antithrombotic agents in the ED and investigated with CT and ECG within 24 hours; however, vascular imaging and neurovascular clinic follow-up were underutilized. For those with neurovascular clinic follow-up, there was an association with reduced risk of subsequent stroke, myocardial infarction, or vascular death. RÉSUMÉObjectifs: L'étude visait, d'une part, à examiner si la prise en charge des accidents ischémiques transitoires (AIT) au service des urgences de la région sanitaire Nova Scotia Capital District Health Authority respectait les recommandations canadiennes en matière de pratiques exemplaires, et, d'autre part, à évaluer l'incidence du suivi dans un service de consultations externes, spécialisé en maladies neurovasculaires. Méthode: Les auteurs ont procédé à un examen rétrospectif des dossiers de tous les patients chez qui avait été posé un diagnostic d'AIT et qui avaient reçu leur congé du SU, dans la région mentionnée, et ce, du 1 er janvier 2011 au 31 décembre 2012. La mortalité et le taux de réadmission au bout de 90 jours ont été calculés à l'aide de modèles de risques proportionnels de Cox, de la méthode d'estimation de Kaplan-Meyer et d'analyses appariées de propension. Résultats: Sur 686 patients examinés au SU pour un AIT, 88,3% ont été soumis à une tomodensitométrie (TDM); 86,3%, à un ECG; 35%, à un examen par imagerie vasculaire dans les 24 heures suivant le triage et 36% ont été vus dans un service de consultations spécialisé en maladies neurovasculaires; 4,2% ont subi un accident vasculaire cérébral (AVC) ou un infarctus du myocarde (...

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Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack

Cited by 1,400 publications

References 551 publications

Adherence to Guidelines: Experience of a Canadian Stroke Prevention Clinic

Adherence to Guidelines: Experience of a Canadian Stroke Prevention Clinic

Acetylsalicylic Acid, but Not Clopidogrel, Inhibits Therapeutically Induced Cerebral Arteriogenesis in the Hypoperfused Rat Brain

Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

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