Canadian stroke best practice recommendations: Secondary prevention of stroke, sixth edition practice guidelines, update 2017

Abstract

The 2017 update of The Canadian Stroke Best Practice Recommendations for the Secondary Prevention of Stroke is a collection of current evidence-based recommendations intended for use by clinicians across a wide range of settings. The goal is to provide guidance for the prevention of ischemic stroke recurrence through the identification and management of modifiable vascular risk factors. Recommendations include those related to diagnostic testing, diet and lifestyle, smoking, hypertension, hyperlipidemia, diabetes, antiplatelet and anticoagulant therapies, carotid artery disease, atrial fibrillation, and other cardiac conditions. Notable changes in this sixth edition include the development of core elements for delivering secondary stroke prevention services, the addition of a section on cervical artery dissection, new recommendations regarding the management of patent foramen ovale, and the removal of the recommendations on management of sleep apnea. The Canadian Stroke Best Practice Recommendations include a range of supporting materials such as implementation resources to facilitate the adoption of evidence to practice, and related performance measures to enable monitoring of uptake and effectiveness of the recommendations. The guidelines further emphasize the need for a systems approach to stroke care, involving an interprofessional team, with access to specialists regardless of patient location, and the need to overcome geographic barriers to ensure equity in access within a universal health care system.

Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline

“…Clinicians sometimes use alternatives of cilostazole or a combination of dipyridamole and aspirin, both referred to for this recommendation as single agent therapy 6789…”

SCAI expert consensus statement on operator and institutional requirements for PFO closure for secondary prevention of paradoxical embolic stroke

“…We can anticipate that PFO closure in the management of patients with unexplained stroke will assume a greater role as the guideline documents regarding management of these patients are revised. This has already begun as evidenced by the recently published Canadian Stroke Best Practice Recommendations stating that PFO closure is suitable for patients in alignment with the FDA labeling with level of evidence A . As the penetration of percutaneous PFO closure increases, physicians have a fiduciary responsibility to ensure the safe and effective application of these technologies.…”

“…12 Recommendations stating that PFO closure is suitable for patients in alignment with the FDA labeling with level of evidence A. 16 As the penetration of percutaneous PFO closure increases, physicians have a fiduciary responsibility to ensure the safe and effective application of these technologies. Therefore, it is essential that stakeholders have a thorough understanding of the cognitive and technical skillsets surrounding PFO closure.…”

Influencing factors of AF detection in cryptogenic stroke: A survey among neurologists in China

“…cross-sectional study provides an overview of AF detection by neurologists in real-word clinical practice among cryptogenic stroke patients in Hubei province in China. The main findings of this survey were that: 1) Almost all of the neurologists knew the stroke risk of AF, but only 53% of them would always detect AF in cryptogenic stroke patients; 2) The main obstacles of AF detection were insufficient knowledge, high expense, inactive attitude, tense doctor-patient relationship and equipment deficiency; 3) Neurologists' attitude and continuing medical education were important factors influencing AF detection behavior.AF detection in initially diagnosed cryptogenic stroke patient was well emphasized and recommended by clinical guidelines[17,[19][20][21][22]. However, only 53.0% of the respondents would always detect AF in cryptogenic stroke patients, forming a substantial gap between management recommendations and everyday clinical practice, even though almost all the neurologists in this survey knew the high recurrence risk of stroke associated with AF.…”