Australian and New Zealand Living Clinical Guidelines for Stroke Management - Chapter 4 of 8: Secondary prevention

Published by Stroke Foundation on Sep 2, 2024

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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 Guideline is 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. Melbourne Australia. © No part of this publication can be reproduced by any process without permission from the Stroke Foundation. July 2024.

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

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Abstract

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

Language

en-au

PICOS

PICO 10.1

Population
People recovery from stroke or TIA
Intervention
Diet related interventions
Comparator
control
Outcomes

PICO 20.1

Population
Adults with stroke
Intervention
Interventions reducing sedentary behaviours
Comparator
Control
Outcomes

PICO 40.1

Population
Adults with stroke
Intervention
Smoking cessations
Comparator
Control or usual care
Outcomes

PICO 50.1

Population
Adults with stroke
Intervention
Behavioural or educational interventions designed to improve medication adherence/concordance
Comparator
Usual care or modified usual care
Outcomes

PICO 50.2

Population
Adults with stroke
Intervention
Organisational interventions
Comparator
Usual care
Outcomes

PICO 50.3

Population
Adults with cardiovascular disease
Intervention
Interventions designed to improve medication adherence/concordance
Comparator
Usual care or modified usual care
Outcomes

PICO 60.1

Population
Adults with recent stroke
Intervention
Lower target of blood pressure (less than 130 mmHg)
Comparator
Higher target of blood pressure (130-149 mm Hg)
Outcomes

PICO 60.2

Population
Adults with previous stroke or TIA
Intervention
Blood pressure reduction medication
Comparator
Control/placebo
Outcomes

PICO 60.3

Population
Adults with acute ICH
Intervention
Blood pressure lowering
Comparator
Control
Outcomes

PICO 60.4

Population
Adults with acute ischaemic stroke
Intervention
Blood pressure lowering
Comparator
Control
Outcomes

PICO 60.5

Population
Adults with acute stroke
Intervention
Continue pre-stroke antihypertensives
Comparator
Stop pre-stroke antihypertensives
Outcomes

PICO 70.1

Population
Adults with stroke with non-valvular atrial fibrillation
Intervention
DOACs
Comparator
Warfarin
Outcomes

PICO 70.2

Population
Adults with stroke
Intervention
Anticoagulant
Comparator
Antiplatelets
Outcomes

PICO 70.3

Population
Adults with stroke with left atrial appendage occlusion
Intervention
Closure of left atrial appendage
Comparator
anticoagulant
Outcomes

PICO 70.4

Population
Adults with stroke and non-valvular atrial fibrillation
Intervention
Early (within 1 week) commencement of DOAC
Comparator
Later (within 2 week) commencement of DOAC
Outcomes

PICO 80.1

Population
Adults with stroke
Intervention
Aspirin only
Comparator
Placebo
Outcomes

PICO 80.2

Population
Adults with stroke
Intervention
Ticlopidine only
Comparator
Placebo
Outcomes

PICO 80.3

Population
Adults with stroke
Intervention
Aspirin plus dipyridamole
Comparator
Placebo
Outcomes

PICO 80.4

Population
Adults with stroke
Intervention
Aspirin plus dipyridamole
Comparator
Aspirin alone
Outcomes

PICO 80.5

Population
Adults with stroke
Intervention
Aspirin plus clopidogrel
Comparator
Placebo
Outcomes

PICO 80.6

Population
Adults with stroke
Intervention
Aspirin plus clopidogrel
Comparator
Aspirin or clopidogrel alone
Outcomes

PICO 80.7

Population
Adults with stroke
Intervention
Clopidogrel
Comparator
Placebo
Outcomes

PICO 80.8

Population
Adults with stroke
Intervention
Clopidogrel
Comparator
Aspirin (75 - 162mg daily)
Outcomes

PICO 80.9

Population
Adults with AF and unsuitable for vitamin K antagonist therapy
Intervention
Factor Xa inhibitor
Comparator
Aspirin
Outcomes

PICO 80.10

Population
Adults with stroke due to ICH
Intervention
Antiplatelet therapy
Comparator
Avoid anti-platelet therapy
Outcomes

PICO 80.11

Population
Adults with stroke
Intervention
Ticagrelor plus aspirin
Comparator
Aspirin
Outcomes

PICO 80.12

Population
Adults with stroke
Intervention
Prasugrel
Comparator
Clopidogrel
Outcomes

PICO 80.13

Population
Adults with cryptogenic stroke and atrial cardiopathy
Intervention
Apixaban
Comparator
Aspirin
Outcomes

PICO 80.14

Population
Adults with high-risk TIA or minor stroke
Intervention
Ticagrelor plus aspirin
Comparator
Clopidogrel plus aspirin
Outcomes

PICO 90.1

Population
Patients with previous stroke or TIA
Intervention
Statins
Comparator
Control
Outcomes

PICO 90.2

Population
Patients with previous stroke or TIA
Intervention
more intense LDL-C lowering target
Comparator
less intense LDL-C lowering target
Outcomes

PICO 90.3

Population
Patients with previous stroke
Intervention
Fibrates
Comparator
Control
Outcomes

PICO 90.4

Population
People with stroke or transient ischaemic attack
Intervention
Peroxisome proliferator-activated receptor gamma agonists agonists
Comparator
placebo
Outcomes

PICO 100.1

Population
Adults with symptomatic carotid occlusion
Intervention
Extracranial-intracranial arterial bypass surgery
Comparator
Medical therapy alone
Outcomes

PICO 100.2

Population
Adults with recently symptomatic carotid stenosis
Intervention
Carotid artery stenting
Comparator
Carotid endarterectomy
Outcomes

PICO 100.3

Population
Adults with asymptomatic carotid stenosis
Intervention
Carotid artery stenting
Comparator
Carotid endarterectomy
Outcomes

PICO 100.4

Population
Adults with asymptomatic carotid stenosis
Intervention
Carotid endarterectomy
Comparator
Medical therapy alone
Outcomes

PICO 100.5

Population
Adults with symptomatic carotid stenosis
Intervention
Endarterectomy
Comparator
no endarterectomy
Outcomes

PICO 110.1

Population
Stroke patients with cervical artery dissection
Intervention
Anticoagulant
Comparator
Antiplatelet
Outcomes

PICO 110.2

Population
Adults with stroke with cervical artery dissection
Intervention
Vitamin K antagonist
Comparator
Anticoagulants (NOAC)
Outcomes

PICO 120.1

Population
Adults with venous sinus thrombosis
Intervention
Anticoagulation (heparin then vitamin K antagonist)
Comparator
Control
Outcomes

PICO 120.2

Population
Adults with venous sinus thrombosis
Intervention
Low molecular weight heparin
Comparator
Unfractionated heparin
Outcomes

PICO 120.3

Population
Adults with venous sinus thrombosis
Intervention
Anticoagulation (DOACs)
Comparator
Control
Outcomes

PICO 120.4

Population
Adults with venous sinus thrombosis
Intervention
Endovascular treatment plus medical management
Comparator
Standard care
Outcomes

PICO 140.1

Population
Stroke patients with PFO
Intervention
Closure
Comparator
Medical therapy
Outcomes

PICO 140.2

Population
Stroke patients with PFO
Intervention
Anticoagulation therapy
Comparator
Antiplatelet therapy
Outcomes

PICO 150.1

Population
Women with established cardiovascular disease
Intervention
Hormone therapy
Comparator
Placebo
Outcomes

PICO 160.1

Population
All women in childbearing years
Intervention
Oral contraceptive use
Comparator
Control
Outcomes

PICO 170.1

Population
People recovering from stroke
Intervention
Educational or behavioural interventions for patients
Comparator
usual care
Outcomes

PICO 170.2

Population
People recovering from stroke
Intervention
Organisational interventions
Comparator
usual care
Outcomes

PICO 170.3

Population
People recovery from stroke or TIA
Intervention
Physical activity interventions
Comparator
control
Outcomes