Stroke: the way things really are

Area of Science:

• Neurology
• Evidence-Based Medicine
• Clinical Trials

Background:

• Governmental regulations necessitate distinguishing scientifically validated therapeutic modalities from anecdotal information for stroke prevention and management.
• Medico-legal considerations require a clear demarcation between proven and unproven stroke treatments.

Purpose of the Study:

• To review evidence for established stroke prevention modalities in high-risk patients.
• To discuss controversial or unproven therapies lacking scientific validation.
• To emphasize the importance of evidence-based medicine in defining the standard of care for stroke.

Main Methods:

• Systematic review of controlled clinical trials and scientific literature.
• Analysis of evidence supporting antiplatelet drugs, anticoagulants, and endarterectomy for stroke prevention.
• Discussion of therapeutic modalities lacking scientific proof.

Main Results:

• Evidence for antiplatelet drugs, anticoagulants, and endarterectomy in stroke prevention is summarized, along with their limitations.
• Therapeutic modalities without scientific proof, such as anticoagulation for progressing stroke, are critically examined.
• Current treatments for acute stroke remain disappointing despite promising preclinical findings, possibly due to narrow therapeutic windows.

Conclusions:

• Controlled, randomized, multiple-center clinical trials are effective in determining the efficacy of stroke therapies.
• Anecdotal data in stroke treatment can be misleading and potentially harmful.
• Awareness of established scientific knowledge versus unknowns is essential in stroke care.