2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

Abstract

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

Aspirin: 120 years of innovation. A report from the 2017 Scientific Conference of the International Aspirin Foundation, 14 September 2017, Charité, Berlin

“…The Chinese clinical guidelines for the secondary prevention of ischaemic stroke and TIA recommend an optimal dosage of aspirin between 75 mg/day and 150 mg/day. A combination of aspirin and clopidogrel for 21 days is recommended for patients with minor stroke or high-risk TIA within 24 hour of onset [ 10 ]. These recommendations are based on the CHANCE trial [ 11 ].…”

Rationale and Study Design for a Single-Arm Phase IIa Study Investigating Feasibility of Preventing Ischemic Cerebrovascular Events in High-Risk Patients with Acute Non-disabling Ischemic Cerebrovascular Events Using Remote Ischemic Conditioning

“…[ 2 ] The combination of aspirin and clopidogrel within 24 h of an AMIS/TIA and continuation for 21 days was recommended according to the latest Chinese and American guidelines for the secondary prevention of stroke. [ 3 4 ]…”

Prediction of stroke risk in patients with transient ischemic attack: ABCD score and its derived scores

“…1,3,20,21 In recent years, with the development of imaging, radiographic abnormality in evaluating the risk of stroke after TIA is more and more important significance.…”

“…1 To date, increased incidence of TIA is observed from 18% of people aged 45 and above and who at least experienced at least one TIA. 2 Reports suggested that percentages of other TIAs occurring within 7 d after cerebral infarction rate reach as high as 8.0% to 10.5%, whereas the incidence of 90 d is 10.5% -14.6%, and the possibility of serious incidence (such as death and asymptomatic cerebral infarction, etc.)…”

“…2 In 1958, for the first time, TIA became recurrent for a few minutes to several hours, with most attacks spanning 5-10 min; in 1961, TIA was defined as single or multiple brain dysfunction with no any residual symptoms usually lasting less than 1h; in 1965, TIA was defined as the sudden emergence of focal or full cranial nerve dysfunction at a duration of not more than 24 hours, and with the exclusion of vascular origin; In 2002, the new concept of TIA was proposed because of local brain or retinal ischemic caused by transient neurologic deficit attack with typical clinical symptoms lasting less than 1h, and without evidence of acute cerebral infarction imaging; In 2009, the American Heart Association(AHA) and the American Stroke Association (ASA) suggested the new concept of TIA, stating that the disease is caused by focal brain, spinal cord, or retinal ischemic but is not accompanied by acute infarction and transient nerve dysfunction. 1,2,6 Based on the concept of TIA, the attention to TIA from clinical symptoms to histology change and new concept depends on imaging studies. In recent years, studies showed extremely high short-term risk of stroke after TIA and clinical significance of early risk stratification and intervention in patients with TIA.…”