(Australian) Clinical Guidelines for Stroke Management - Chapter 4 of 8: Secondary prevention

Main Editor Stroke Foundation
Language en
Last Update Jul 30, 2019
Published Date Jul 30, 2019
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Disclaimer

These Clinical Guidelines are a general guide to appropriate practice, to be followed subject to the clinician’s judgment and the patient’s preference in each individual case. The Clinical Guidelines are designed to provide information to assist decision-making and are based on the best evidence available at the time of development. The Clinical Guidelines can be viewed at www.informme.org.au - Citation: Stroke Foundation. Clinical Guidelines for Stroke Management 2019. Melbourne Australia. © No part of this publication can be reproduced by any process without permission from the Stroke Foundation. August 2019.

Sponsors The Stroke Foundation gratefully acknowledges the financial assistance provided by the Australian Government via the Medical Research Future Fund. The development of the final recommendations has not been influenced by the views or interests of the funding body.
Abstract

This is the fourth in a series of eight guideline chapters that provide evidence-based recommendations for recovery from stroke and TIA.

PICOS
PICO 6.0
P: Adults with stroke
I: Behavioural, educational or organisations interventions designed to improve medication adherence/concordance
C: Usual care or modified usual care
O:

PICO 7.0
P: Adults with recent stroke
I: Lower target of blood pressure (less than 130 mmHg)
C: Higher target of blood pressure (130-149 mm Hg)
O:

PICO 8.0
P: Adults with stroke
I: Aspirin only
C: Placebo
O:

PICO 9.0
P: Adults with stroke with non-valvular atrial fibrillation
I: DOACs
C: Warfarin
O:

PICO 10.0
P: Patients with previous stroke
I: Fibrates
C: Control
O:

PICO 11.0
P: Adults with symptomatic carotid occlusion
I: Extracranial-intracranial arterial bypass surgery
C: Medical therapy alone
O:

PICO 12.0
P: Stroke patients with cervical artery dissection
I: Anticoagulant
C: Antiplatelet
O:

PICO 13.0
P: Adults with venous sinus thrombosis
I: Anticoagulation (heparin)
C: Control
O:

PICO 15.0
P: Stroke patients with PFO
I: Closure
C: Medical therapy
O:

PICO 16.0
P: Women with established cardiovascular disease
I: Hormone therapy
C: Placebo
O:

PICO 17.0
P: All women in childbearing years
I: Oral contraceptive use
C: Control
O:

PICO 6.0
P: Adults with stroke
I: Organisational interventions
C: Usual care
O:

PICO 7.0
P: Adults with previous stroke or TIA
I: Blood pressure reduction medication
C: Control/placebo
O:

PICO 8.0
P: Adults with stroke
I: Ticlopidine only
C: Placebo
O:

PICO 9.0
P: Adults with stroke
I: Vitamin K antagonists
C: Antiplatelets
O:

PICO 10.0
P: Patients with previous stroke or TIA
I: Statins
C: Control
O:

PICO 11.0
P: Adults with recently symptomatic carotid stenosis
I: Carotid artery stenting
C: Carotid endarterectomy
O:

PICO 13.0
P: Adults with venous sinus thrombosis
I: Low molecular weight heparin
C: Unfractionated heparin
O:

PICO 15.0
P: Stroke patients with PFO
I: Warfarin
C: Aspirin
O:

PICO 7.0
P: Adults with ICH
I: Blood pressure lowering
C: Control
O:

PICO 8.0
P: Adults with stroke
I: Aspirin plus dipyridamole
C: Placebo
O:

PICO 9.0
P: Adults with stroke with valvular atrial fibrillation
I: Warfarin
C: Other anticoagulants
O:

PICO 11.0
P: Adults with asymptomatic carotid stenosis
I: Carotid artery stenting
C: Carotid endarterectomy
O:

PICO 7.0
P: Adults with ischaemic stroke
I: Blood pressure lowering
C: Control
O:

PICO 8.0
P: Adults with stroke
I: Aspirin plus dipyridamole
C: Aspirin alone
O:

PICO 11.0
P: Adults with asymptomatic carotid stenosis
I: Carotid endarterectomy
C: Medical therapy alone
O:

PICO 7.0
P: Adults with acute stroke
I: Continue pre-stroke antihypertensives
C: Stop pre-stroke antihypertensives
O:

PICO 8.0
P: Adults with stroke
I: Aspirin plus clopidogrel
C: Placebo
O:

PICO 11.0
P: Adults with symptomatic carotid stenosis
I: Endarterectomy
C: no endarterectomy
O:

PICO 7.0
P: People with hypertension
I: Intensive blood pressure lowering therapy
C: Lower intensity blood pressure lowering therapy
O:

PICO 8.0
P: Adults with stroke
I: Aspirin plus clopidogrel
C: Aspirin or clopidogrel alone
O:

PICO 7.0
P: Adults
I: Blood pressure lowering therapy
C: Placebo or alternative blood pressure lowering therapy
O:

PICO 8.0
P: Adults with stroke
I: Clopidogrel
C: Placebo
O:

PICO 8.0
P: Adults with stroke
I: Clopidogrel
C: Aspirin (75 - 162mg daily)
O:

PICO 8.0
P: Adults with AF and unsuitable for vitamin K antagonist therapy
I: Factor Xa inhibitor
C: Aspirin
O: