I don't think a single person here thinks outside the box and thus misses actions that are more likely to be implemented. But I should never criticize the medical gods.
http://stroke.ahajournals.org/content/42/1/227.full
A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
- Karen L. Furie, MD, MPH, FAHA, Chair;
- Scott E. Kasner, MD, MSCE, FAHA, Vice Chair;
- Robert J. Adams, MD, MS, FAHA;
- Gregory W. Albers, MD;
- Ruth L. Bush, MD, MPH;
- Susan C. Fagan, PharmD, FAHA;
- Jonathan L. Halperin, MD, FAHA;
- S. Claiborne Johnston, MD, PhD;
- Irene Katzan, MD, MS, FAHA;
- Walter N. Kernan, MD;
- Pamela H. Mitchell, PhD, CNRN, RN, FAAN, FAHA;
- Bruce Ovbiagele, MD, MS, FAHA;
- Yuko Y. Palesch, PhD;
- Ralph L. Sacco, MD, MS, FAHA, FAAN;
- Lee H. Schwamm, MD, FAHA;
- Sylvia Wassertheil-Smoller, MD, PhD, FAHA;
- Tanya N. Turan, MD, FAHA;
- Deidre Wentworth, MSN, RN
- on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research
Abstract
The aim of this updated statement is to
provide comprehensive and timely evidence-based recommendations on the
prevention
of ischemic stroke among survivors of ischemic
stroke or transient ischemic attack. Evidence-based recommendations are
included
for the control of risk factors, interventional
approaches for atherosclerotic disease, antithrombotic treatments for
cardioembolism,
and the use of antiplatelet agents for
noncardioembolic stroke. Further recommendations are provided for the
prevention of
recurrent stroke in a variety of other specific
circumstances, including arterial dissections; patent foramen ovale;
hyperhomocysteinemia;
hypercoagulable states; sickle cell disease;
cerebral venous sinus thrombosis; stroke among women, particularly with
regard
to pregnancy and the use of postmenopausal
hormones; the use of anticoagulation after cerebral hemorrhage; and
special approaches
to the implementation of guidelines and their
use in high-risk populations.
Stroke is a
major source of mortality and morbidity in the United States. Survivors
of a transient ischemic attack (TIA) or
stroke represent a population at increased risk of
subsequent stroke. Approximately one quarter of the 795 000 strokes that
occur each year are recurrent events. The true
prevalence of TIA is difficult to gauge because a large proportion of
patients
who experience a TIA fail to report it to a
healthcare provider.1
On the basis of epidemiological data defining the determinants of
recurrent stroke and the results of clinical trials, it
is possible to derive evidence-based
recommendations to reduce stroke risk. Notably, much of the existing
data come from studies
with limited numbers of older adults, women, and
diverse ethnic groups, and additional research is needed to confirm the
generalizability
of the published findings.
The aim of this statement is to provide clinicians with the most up-to-date evidence-based recommendations for the prevention
of ischemic stroke among survivors of ischemic stroke or TIA.
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