Primary and secondary prevention of cerebral ischemia

Diener, H.‐C.; Aichner, F.; Bode, Christoph; Böhm, Michael; Eckstein, H.‐H.; Einhäupl, Karl M.; Endres, M; Forsting, F.; Gesenhues, Stefan; Grond, Martin; Haberl, Ralph; Hacke, W.; Hennerici, Michael G.; Lyrer, P; Link, Alissa; Ringelstein, Bernd; Ringleb, Peter; Schrader, Jürgen; Weimar, Christian

doi:10.1055/s-0029-1223537

Cited by 2 publications

(1 citation statement)

References 73 publications

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“…1 ). 23 – 131 We found four guidelines from 4 (14%) of the 29 World Bank low-income group countries (Ethiopia, Rwanda, Somalia, Uganda); 13 guidelines from 9 (18%) of 50 lower-middle-income countries (Cameroon, El Salvador, India, Kenya, Mongolia, Pakistan, Philippines, Solomon Islands and Sri Lanka); 24 guidelines from 15 (27%) of 56 upper-middle-income countries (Argentina, Brazil, China, Colombia, Ecuador, Georgia, Guatemala, Malaysia, Mexico, Namibia, Peru, Russian Federation, South Africa, Thailand and Tuvalu); and 67 guidelines from 19 (23%) of 83 high-income countries or territory (Australia, Canada, Chile, Germany, Ireland, Italy, Japan, Netherlands, New Zealand, Oman, Qatar, Republic of Korea, Singapore, Spain, Sweden, Switzerland, Taiwan, China, United Kingdom of Great Britain and Northern Ireland, and United States of America) ( Table 1 ; available at https://www.who.int/publications/journals/bulletin/ ).…”

Section: Resultsmentioning

confidence: 99%

Quality of stroke guidelines in low- and middle-income countries: a systematic review

Yaria

Gil

Makanjuola

et al. 2021

Bull World Health Org

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Objective To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. Methods We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. Findings We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. Conclusion Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.

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Section: Resultsmentioning

confidence: 99%

Quality of stroke guidelines in low- and middle-income countries: a systematic review

Yaria

Gil

Makanjuola

et al. 2021

Bull World Health Org

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Baseline characteristics of the 3096 patients recruited into the ‘Triple Antiplatelets for Reducing Dependency after Ischemic Stroke’ trial

Bath

Appleton

Beridze³

et al. 2016

International Journal of Stroke

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Background The risk of recurrence following ischemic stroke or transient ischemic attack is highest immediately after the event. Antiplatelet agents are effective in reducing the risk of recurrence and two agents are superior to one in the early phase after ictus. Design The triple antiplatelets for reducing dependency after ischemic stroke trial was an international multicenter prospective randomized open-label blinded-endpoint trial that assessed the safety and efficacy of short-term intensive antiplatelet therapy with three agents (combined aspirin, clopidogrel and dipyridamole) as compared with guideline treatment in acute ischemic stroke or transient ischemic attack. The primary outcome was stroke recurrence and its severity, measured using the modified Rankin Scale at 90 days. Secondary outcomes included recurrent vascular events, functional measures (cognition, disability, mood, quality of life), and safety (bleeding, death, serious adverse events). Data are number (%) or mean (standard deviation, SD). Results Recruitment ran from April 2009 to March 2016; 3096 patients were recruited from 106 sites in four countries (Denmark 1.6%, Georgia 2.7%, New Zealand 0.2%, UK 95.4%). Randomization characteristics included: age 69.0 (10.1) years; male 1945 (62.8%); time onset to randomization 29.4 (11.9) h; stroke severity (National Institutes for Health Stroke Scale) 2.8 (3.6); blood pressure 143.5 (18.2)/79.5 (11.4) mmHg; IS 2143 (69.2%), transient ischemic attack 953 (30.8%). Conclusion Triple antiplatelets for reducing dependency after ischemic stroke was a large trial of intensive/triple antiplatelet therapy in acute ischemic stroke and transient ischemic attack, and included participants from four predominantly Caucasian countries who were representative of patients in many western stroke services.

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Primary and secondary prevention of cerebral ischemia

Cited by 2 publications

References 73 publications

Quality of stroke guidelines in low- and middle-income countries: a systematic review

Quality of stroke guidelines in low- and middle-income countries: a systematic review

Baseline characteristics of the 3096 patients recruited into the ‘Triple Antiplatelets for Reducing Dependency after Ischemic Stroke’ trial

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