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

Published by Stroke Foundation on Sep 7, 2020

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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.

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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.

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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.

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en

PICOS

PICO 5.1

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

PICO 5.2

Population
Adults with stroke
Intervention
Organisational interventions
Comparator
Usual care
Outcomes

PICO 6.1

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 6.2

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

PICO 6.3

Population
Adults with ICH
Intervention
Blood pressure lowering
Comparator
Control
Outcomes

PICO 6.4

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

PICO 6.5

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

PICO 6.6

Population
People with hypertension
Intervention
Intensive blood pressure lowering therapy
Comparator
Lower intensity blood pressure lowering therapy
Outcomes

PICO 6.7

Population
Adults
Intervention
Blood pressure lowering therapy
Comparator
Placebo or alternative blood pressure lowering therapy
Outcomes

PICO 7.1

Population
Adults with stroke
Intervention
Aspirin only
Comparator
Placebo
Outcomes

PICO 7.2

Population
Adults with stroke
Intervention
Ticlopidine only
Comparator
Placebo
Outcomes

PICO 7.3

Population
Adults with stroke
Intervention
Aspirin plus dipyridamole
Comparator
Placebo
Outcomes

PICO 7.4

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

PICO 7.5

Population
Adults with stroke
Intervention
Aspirin plus clopidogrel
Comparator
Placebo
Outcomes

PICO 7.6

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

PICO 7.7

Population
Adults with stroke
Intervention
Clopidogrel
Comparator
Placebo
Outcomes

PICO 7.8

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

PICO 7.9

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

PICO 8.1

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

PICO 8.2

Population
Adults with stroke
Intervention
Vitamin K antagonists
Comparator
Antiplatelets
Outcomes

PICO 8.3

Population
Adults with stroke with valvular atrial fibrillation
Intervention
Warfarin
Comparator
Other anticoagulants
Outcomes

PICO 9.1

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

PICO 9.2

Population
Patients with previous stroke or TIA
Intervention
more intense LDL-C lowering target (<1.8 mmol/L)
Comparator
less intense LDL-C lowering target (2.3-2.8 mmol/L)
Outcomes

PICO 9.3

Population
Patients with previous stroke
Intervention
Fibrates
Comparator
Control
Outcomes

PICO 9.4

Population
Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack
Intervention
Peroxisome proliferator-activated receptor gamma agonists agonists
Comparator
placebo
Outcomes

PICO 10.1

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

PICO 10.2

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

PICO 10.3

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

PICO 10.4

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

PICO 10.5

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

PICO 11.1

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

PICO 12.1

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

PICO 12.2

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

PICO 14.1

Population
Stroke patients with PFO
Intervention
Closure
Comparator
Medical therapy
Outcomes

PICO 14.2

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

PICO 15.1

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

PICO 16.1

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