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Published on: February 28, 2012

Stroke prevention

Gregory Yh Lip1, Lalit Kalra

  • 1University Department of Medicine, City Hospital, Birmingham, UK.

BMJ Clinical Evidence
|May 19, 2009
PubMed

Insights

Individuals with a history of stroke or transient ischemic attack (TIA) face high risks for vascular events. This review evaluates preventive treatments, including anticoagulants and antiplatelets, to reduce recurrent stroke risk.

Area of Science:

  • Cardiology
  • Neurology
  • Evidence-Based Medicine

Background:

  • Individuals with a history of stroke or transient ischemic attack (TIA) are at elevated risk for subsequent vascular events, including myocardial infarction and recurrent stroke.
  • Approximately 10% of individuals experience a recurrent stroke within the first year post-event, with a continued risk of 5% annually thereafter.

Purpose of the Study:

  • To systematically review the effectiveness and safety of various preventive interventions for individuals with a history of stroke or TIA.
  • To assess the impact of anticoagulant and antiplatelet therapies in patients with atrial fibrillation, with or without a prior history of stroke or TIA.

Main Methods:

  • A systematic review was conducted, searching major databases (Medline, Embase, Cochrane Library) up to September 2006.
  • Included studies comprised systematic reviews, randomized controlled trials (RCTs), and observational studies.
  • Harms alerts from regulatory agencies (FDA, MHRA) were also incorporated.

Main Results:

  • 120 systematic reviews, RCTs, and observational studies met the inclusion criteria.
  • A GRADE evaluation was performed to assess the quality of evidence for different interventions.
  • The review synthesized data on a wide range of preventive strategies.

Conclusions:

  • The review provides information on the effectiveness and safety of interventions such as alternative antiplatelet regimens, anticoagulation, aspirin, blood pressure reduction, carotid revascularization procedures, and cholesterol reduction.
  • Evidence for various blood pressure-lowering regimens and vitamin B supplements (including folate) was also presented.
  • The findings aim to inform clinical decision-making for secondary stroke prevention.
Abstract

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