Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy

Richard H. Swartz; Noor Niyar N. Ladhani; Norine Foley; Kara Nerenberg; Simerpreet Bal; Jon Barrett; Cheryl Bushnell; Wee Shian Chan; Radha Chari; Dariush Dowlatshahi; Meryem El Amrani; Shital Gandhi; Gord Gubitz; Michael D. Hill; Andra James; Thomas Jeerakathil; Albert Jin; Adam Kirton; Sylvain Lanthier; Andrea Lausman; Lisa Rae Leffert; Jennifer Mandzia; Bijoy Menon; Aleksandra Pikula; Alexandre Poppe; Jayson Potts; Joel Ray; Gustavo Saposnik; Mukul Sharma; Eric E. Smith; Sanjit Bhogal; Elisabeth Smitko; M. Patrice Lindsay

doi:10.1177/1747493017743801

Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy

Richard H. Swartz, Noor Niyar N. Ladhani, Norine Foley, Kara Nerenberg, Simerpreet Bal, Jon Barrett, Cheryl Bushnell, Wee Shian Chan, Radha Chari, Dariush Dowlatshahi, Meryem El Amrani, Shital Gandhi, Gord Gubitz, Michael D. Hill, Andra James, Thomas Jeerakathil, Albert Jin, Adam Kirton, Sylvain Lanthier, Andrea LausmanLisa Rae Leffert, Jennifer Mandzia, Bijoy Menon, Aleksandra Pikula, Alexandre Poppe, Jayson Potts, Joel Ray, Gustavo Saposnik, Mukul Sharma, Eric E. Smith, Sanjit Bhogal, Elisabeth Smitko, M. Patrice Lindsay

Medicine

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31 Citas (Scopus)

Resumen

The Canadian Stroke Best Practice Consensus Statement: Secondary Stroke Prevention during Pregnancy, is the first of a two-part series devoted to stroke in pregnancy. This document focuses on unique aspects of secondary stroke prevention in a woman with a prior history of stroke or transient ischemic attack who is, or is planning to become, pregnant. Although stroke is relatively rare in this cohort, several aspects of pregnancy can increase stroke risk during or immediately after pregnancy. The rationale for the development of this consensus statement is based on the premise that stroke in this group requires a specifically-tailored management approach. No other broad-based, stroke-specific guidelines or consensus statements exist currently. Underpinning the development of this document was the concept that maternal health is vital for fetal wellbeing; therefore, management decisions should be based on the confluence of two clinical considerations: (a) decisions that would be made if the patient was not pregnant and (b) decisions that would be made if the patient had not had a stroke. While empirical research in this area is limited, this consensus document is based on the best available literature and guided by expert consensus. Issues addressed in this document include general management considerations for secondary stroke prevention, the use of antithrombotics, blood pressure management, lipid management, diabetes care, and management for specific ischemic stroke etiologies in pregnancy. The focus is on maternal and fetal health while minimizing risks of a recurrent stroke, through counseling, monitoring, and the safety of select pharmacotherapy. These statements are appropriate for health care professionals across all disciplines.

Idioma original	English
Páginas (desde-hasta)	406-419
Número de páginas	14
Publicación	International Journal of Stroke
Volumen	13
N.º	4
DOI	https://doi.org/10.1177/1747493017743801
Estado	Published - jun. 1 2018

Nota bibliográfica

Funding Information:
1Sunnybrook Health Sciences Centre, Toronto, Canada 2Faculty of Medicine (Neurology), University of Toronto, Canada 3Faculty of Medicine (Obstetrics and Gynecology), University of Toronto, Canada 4Department of Foods and Nutrition, Western University, London, ON, Canada 5workHORSE Consulting Group, London, ON, Canada 6Department of Medicine, University of Calgary, Canada 7Department of Clinical Neurosciences, University of Calgary, Canada 8Wake Forest Baptist Stroke Center, Wake Forest Baptist Health, Winston Salem, NC, USA 9Department of Obstetric General Internal Medicine, British Columbia Women’s Hospital, Vancouver, Canada 10Department of Medicine & Dentistry, Obstetrics and Gynecology, University of Alberta, Canada 11Ottawa Hospital Research Institute, University of Ottawa, Canada 12Hôpital du Sacré-Coeur de Montréal, Neurology, Montreal, Canada 13Sinai Health System, Toronto, Canada 14Queen Elizabeth II Health Sciences Centre, Halifax, Canada 15Department of Medicine (Neurology), Dalhousie University, Canada 16Calgary Stroke Program, Canada 17Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA 18Department of Medicine & Dentistry (Neurosciences), University of Alberta, Canada 19Department of Medicine, Queen’s University, Canada 20Department of Maternal-Fetal Medicine, St. Michael’s Hospital, Canada 21Department of Obstetric Anesthesia, Massachusetts General Hospital, Boston, MA, USA 22Department of Clinical Neurological Sciences, Western University, London, ON, Canada 23Neurovascular Unit, UHN/Toronto Western Hospital, Toronto, ON, Canada 24Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada 25St. Michael’s Hospital Stroke Research Unit, Toronto, ON, Canada 26Department of Medicine, Division of Neurology, McMaster University, Hamilton, ON, Canada 27Heart and Stroke Foundation of Canada, Toronto, ON, Canada 28Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

Funding Information:
M Patrice Lindsay, Heart and Stroke Foundation of Canada, 2300 Yonge Street, Suite 1300, Box 2414, Toronto, ON, Canada. Email: patrice.lindsay@heartandstroke.ca

Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The following authors have declared conflicts of interest: Dariush Dowlatshahi received honoraria from Bayer and Bristol-Myers Squibb–Pfizer; Michael D Hill received research funding from Medtronic, Stryker, Boehringer Ingelheim, and Bayer; Sylvain Lanthier is a speaker and advisory board member for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb–Pfizer, and Servier; Andrea Lausman is a speaker for Ferring Pharmaceuticals; Bijoy Menon owns stock in QuikFlo Health Inc.; Gustavo Saposnik holds a career award from the Heart and Stroke Foundation; Mukul Sharma is a speaker for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb–Pfizer, and consultant for AZ Therapies and Daiichi Sankyo. The following authors do not have any conflicts of interest relevant to this manuscript: Richard H Swartz, Noor Niyar N Ladhani, M Patrice Lindsay, Norine Foley, Sanjit Bhogal, Simerpreet Bal, Jon Barrett; Cheryl Bushnell, Wee-Shian Chan, Radha Chari Meryem El Amrani,, Shital Gandhi, Gord Gubitz, Andra James, Thomas Jeerakathil, Albert Jin, Adam Kirton, Lisa Leffert, Jennifer Mandzia, Kara Nerenberg, Aleksandra Pikula, Alexandre Poppe, Jayson Potts, Joel Ray, Eric E Smith, and Elisabeth Smitko.

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The development of the Canadian Stroke Best Practice Recommendations including this consensus statement is funded in its entirety by the Heart and Stroke Foundation of Canada. No funds for the development of these guidelines come from commercial interests, including pharmaceutical and device companies. All members of the recommendation writing groups and external reviewers are volunteers and do not receive any remuneration for participation in guideline development, updates and reviews. All participants complete a conflict of interest declaration prior to participation.

Publisher Copyright:
© 2017, © 2017 World Stroke Organization.

ASJC Scopus Subject Areas

Neurology

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Swartz, R. H., Ladhani, N. N. N., Foley, N., Nerenberg, K., Bal, S., Barrett, J., Bushnell, C., Chan, W. S., Chari, R., Dowlatshahi, D., Amrani, M. E., Gandhi, S., Gubitz, G., Hill, M. D., James, A., Jeerakathil, T., Jin, A., Kirton, A., Lanthier, S., ... Lindsay, M. P. (2018). Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy. International Journal of Stroke, 13(4), 406-419. https://doi.org/10.1177/1747493017743801

Swartz, RH, Ladhani, NNN, Foley, N, Nerenberg, K, Bal, S, Barrett, J, Bushnell, C, Chan, WS, Chari, R, Dowlatshahi, D, Amrani, ME, Gandhi, S, Gubitz, G, Hill, MD, James, A, Jeerakathil, T, Jin, A, Kirton, A, Lanthier, S, Lausman, A, Leffert, LR, Mandzia, J, Menon, B, Pikula, A, Poppe, A, Potts, J, Ray, J, Saposnik, G, Sharma, M, Smith, EE, Bhogal, S, Smitko, E & Lindsay, MP 2018, 'Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy', International Journal of Stroke, vol. 13, n.º 4, pp. 406-419. https://doi.org/10.1177/1747493017743801

@article{38f52e4afd9b43879bc57d9821c4c19d,

title = "Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy",

abstract = "The Canadian Stroke Best Practice Consensus Statement: Secondary Stroke Prevention during Pregnancy, is the first of a two-part series devoted to stroke in pregnancy. This document focuses on unique aspects of secondary stroke prevention in a woman with a prior history of stroke or transient ischemic attack who is, or is planning to become, pregnant. Although stroke is relatively rare in this cohort, several aspects of pregnancy can increase stroke risk during or immediately after pregnancy. The rationale for the development of this consensus statement is based on the premise that stroke in this group requires a specifically-tailored management approach. No other broad-based, stroke-specific guidelines or consensus statements exist currently. Underpinning the development of this document was the concept that maternal health is vital for fetal wellbeing; therefore, management decisions should be based on the confluence of two clinical considerations: (a) decisions that would be made if the patient was not pregnant and (b) decisions that would be made if the patient had not had a stroke. While empirical research in this area is limited, this consensus document is based on the best available literature and guided by expert consensus. Issues addressed in this document include general management considerations for secondary stroke prevention, the use of antithrombotics, blood pressure management, lipid management, diabetes care, and management for specific ischemic stroke etiologies in pregnancy. The focus is on maternal and fetal health while minimizing risks of a recurrent stroke, through counseling, monitoring, and the safety of select pharmacotherapy. These statements are appropriate for health care professionals across all disciplines.",

author = "Swartz, {Richard H.} and Ladhani, {Noor Niyar N.} and Norine Foley and Kara Nerenberg and Simerpreet Bal and Jon Barrett and Cheryl Bushnell and Chan, {Wee Shian} and Radha Chari and Dariush Dowlatshahi and Amrani, {Meryem El} and Shital Gandhi and Gord Gubitz and Hill, {Michael D.} and Andra James and Thomas Jeerakathil and Albert Jin and Adam Kirton and Sylvain Lanthier and Andrea Lausman and Leffert, {Lisa Rae} and Jennifer Mandzia and Bijoy Menon and Aleksandra Pikula and Alexandre Poppe and Jayson Potts and Joel Ray and Gustavo Saposnik and Mukul Sharma and Smith, {Eric E.} and Sanjit Bhogal and Elisabeth Smitko and Lindsay, {M. Patrice}",

note = "Funding Information: 1Sunnybrook Health Sciences Centre, Toronto, Canada 2Faculty of Medicine (Neurology), University of Toronto, Canada 3Faculty of Medicine (Obstetrics and Gynecology), University of Toronto, Canada 4Department of Foods and Nutrition, Western University, London, ON, Canada 5workHORSE Consulting Group, London, ON, Canada 6Department of Medicine, University of Calgary, Canada 7Department of Clinical Neurosciences, University of Calgary, Canada 8Wake Forest Baptist Stroke Center, Wake Forest Baptist Health, Winston Salem, NC, USA 9Department of Obstetric General Internal Medicine, British Columbia Women{\textquoteright}s Hospital, Vancouver, Canada 10Department of Medicine & Dentistry, Obstetrics and Gynecology, University of Alberta, Canada 11Ottawa Hospital Research Institute, University of Ottawa, Canada 12H{\^o}pital du Sacr{\'e}-Coeur de Montr{\'e}al, Neurology, Montreal, Canada 13Sinai Health System, Toronto, Canada 14Queen Elizabeth II Health Sciences Centre, Halifax, Canada 15Department of Medicine (Neurology), Dalhousie University, Canada 16Calgary Stroke Program, Canada 17Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA 18Department of Medicine & Dentistry (Neurosciences), University of Alberta, Canada 19Department of Medicine, Queen{\textquoteright}s University, Canada 20Department of Maternal-Fetal Medicine, St. Michael{\textquoteright}s Hospital, Canada 21Department of Obstetric Anesthesia, Massachusetts General Hospital, Boston, MA, USA 22Department of Clinical Neurological Sciences, Western University, London, ON, Canada 23Neurovascular Unit, UHN/Toronto Western Hospital, Toronto, ON, Canada 24Faculty of Medicine, Universit{\'e} de Montr{\'e}al, Montreal, Quebec, Canada 25St. Michael{\textquoteright}s Hospital Stroke Research Unit, Toronto, ON, Canada 26Department of Medicine, Division of Neurology, McMaster University, Hamilton, ON, Canada 27Heart and Stroke Foundation of Canada, Toronto, ON, Canada 28Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Funding Information: M Patrice Lindsay, Heart and Stroke Foundation of Canada, 2300 Yonge Street, Suite 1300, Box 2414, Toronto, ON, Canada. Email: patrice.lindsay@heartandstroke.ca Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The following authors have declared conflicts of interest: Dariush Dowlatshahi received honoraria from Bayer and Bristol-Myers Squibb–Pfizer; Michael D Hill received research funding from Medtronic, Stryker, Boehringer Ingelheim, and Bayer; Sylvain Lanthier is a speaker and advisory board member for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb–Pfizer, and Servier; Andrea Lausman is a speaker for Ferring Pharmaceuticals; Bijoy Menon owns stock in QuikFlo Health Inc.; Gustavo Saposnik holds a career award from the Heart and Stroke Foundation; Mukul Sharma is a speaker for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb–Pfizer, and consultant for AZ Therapies and Daiichi Sankyo. The following authors do not have any conflicts of interest relevant to this manuscript: Richard H Swartz, Noor Niyar N Ladhani, M Patrice Lindsay, Norine Foley, Sanjit Bhogal, Simerpreet Bal, Jon Barrett; Cheryl Bushnell, Wee-Shian Chan, Radha Chari Meryem El Amrani,, Shital Gandhi, Gord Gubitz, Andra James, Thomas Jeerakathil, Albert Jin, Adam Kirton, Lisa Leffert, Jennifer Mandzia, Kara Nerenberg, Aleksandra Pikula, Alexandre Poppe, Jayson Potts, Joel Ray, Eric E Smith, and Elisabeth Smitko. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The development of the Canadian Stroke Best Practice Recommendations including this consensus statement is funded in its entirety by the Heart and Stroke Foundation of Canada. No funds for the development of these guidelines come from commercial interests, including pharmaceutical and device companies. All members of the recommendation writing groups and external reviewers are volunteers and do not receive any remuneration for participation in guideline development, updates and reviews. All participants complete a conflict of interest declaration prior to participation. Publisher Copyright: {\textcopyright} 2017, {\textcopyright} 2017 World Stroke Organization.",

year = "2018",

month = jun,

day = "1",

doi = "10.1177/1747493017743801",

language = "English",

volume = "13",

pages = "406--419",

journal = "International Journal of Stroke",

issn = "1747-4930",

publisher = "Wiley-Blackwell",

number = "4",

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TY - JOUR

T1 - Canadian stroke best practice consensus statement

T2 - Secondary stroke prevention during pregnancy

AU - Swartz, Richard H.

AU - Ladhani, Noor Niyar N.

AU - Foley, Norine

AU - Nerenberg, Kara

AU - Bal, Simerpreet

AU - Barrett, Jon

AU - Bushnell, Cheryl

AU - Chan, Wee Shian

AU - Chari, Radha

AU - Dowlatshahi, Dariush

AU - Amrani, Meryem El

AU - Gandhi, Shital

AU - Gubitz, Gord

AU - Hill, Michael D.

AU - James, Andra

AU - Jeerakathil, Thomas

AU - Jin, Albert

AU - Kirton, Adam

AU - Lanthier, Sylvain

AU - Lausman, Andrea

AU - Leffert, Lisa Rae

AU - Mandzia, Jennifer

AU - Menon, Bijoy

AU - Pikula, Aleksandra

AU - Poppe, Alexandre

AU - Potts, Jayson

AU - Ray, Joel

AU - Saposnik, Gustavo

AU - Sharma, Mukul

AU - Smith, Eric E.

AU - Bhogal, Sanjit

AU - Smitko, Elisabeth

AU - Lindsay, M. Patrice

N1 - Funding Information: 1Sunnybrook Health Sciences Centre, Toronto, Canada 2Faculty of Medicine (Neurology), University of Toronto, Canada 3Faculty of Medicine (Obstetrics and Gynecology), University of Toronto, Canada 4Department of Foods and Nutrition, Western University, London, ON, Canada 5workHORSE Consulting Group, London, ON, Canada 6Department of Medicine, University of Calgary, Canada 7Department of Clinical Neurosciences, University of Calgary, Canada 8Wake Forest Baptist Stroke Center, Wake Forest Baptist Health, Winston Salem, NC, USA 9Department of Obstetric General Internal Medicine, British Columbia Women’s Hospital, Vancouver, Canada 10Department of Medicine & Dentistry, Obstetrics and Gynecology, University of Alberta, Canada 11Ottawa Hospital Research Institute, University of Ottawa, Canada 12Hôpital du Sacré-Coeur de Montréal, Neurology, Montreal, Canada 13Sinai Health System, Toronto, Canada 14Queen Elizabeth II Health Sciences Centre, Halifax, Canada 15Department of Medicine (Neurology), Dalhousie University, Canada 16Calgary Stroke Program, Canada 17Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA 18Department of Medicine & Dentistry (Neurosciences), University of Alberta, Canada 19Department of Medicine, Queen’s University, Canada 20Department of Maternal-Fetal Medicine, St. Michael’s Hospital, Canada 21Department of Obstetric Anesthesia, Massachusetts General Hospital, Boston, MA, USA 22Department of Clinical Neurological Sciences, Western University, London, ON, Canada 23Neurovascular Unit, UHN/Toronto Western Hospital, Toronto, ON, Canada 24Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada 25St. Michael’s Hospital Stroke Research Unit, Toronto, ON, Canada 26Department of Medicine, Division of Neurology, McMaster University, Hamilton, ON, Canada 27Heart and Stroke Foundation of Canada, Toronto, ON, Canada 28Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Funding Information: M Patrice Lindsay, Heart and Stroke Foundation of Canada, 2300 Yonge Street, Suite 1300, Box 2414, Toronto, ON, Canada. Email: patrice.lindsay@heartandstroke.ca Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The following authors have declared conflicts of interest: Dariush Dowlatshahi received honoraria from Bayer and Bristol-Myers Squibb–Pfizer; Michael D Hill received research funding from Medtronic, Stryker, Boehringer Ingelheim, and Bayer; Sylvain Lanthier is a speaker and advisory board member for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb–Pfizer, and Servier; Andrea Lausman is a speaker for Ferring Pharmaceuticals; Bijoy Menon owns stock in QuikFlo Health Inc.; Gustavo Saposnik holds a career award from the Heart and Stroke Foundation; Mukul Sharma is a speaker for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb–Pfizer, and consultant for AZ Therapies and Daiichi Sankyo. The following authors do not have any conflicts of interest relevant to this manuscript: Richard H Swartz, Noor Niyar N Ladhani, M Patrice Lindsay, Norine Foley, Sanjit Bhogal, Simerpreet Bal, Jon Barrett; Cheryl Bushnell, Wee-Shian Chan, Radha Chari Meryem El Amrani,, Shital Gandhi, Gord Gubitz, Andra James, Thomas Jeerakathil, Albert Jin, Adam Kirton, Lisa Leffert, Jennifer Mandzia, Kara Nerenberg, Aleksandra Pikula, Alexandre Poppe, Jayson Potts, Joel Ray, Eric E Smith, and Elisabeth Smitko. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The development of the Canadian Stroke Best Practice Recommendations including this consensus statement is funded in its entirety by the Heart and Stroke Foundation of Canada. No funds for the development of these guidelines come from commercial interests, including pharmaceutical and device companies. All members of the recommendation writing groups and external reviewers are volunteers and do not receive any remuneration for participation in guideline development, updates and reviews. All participants complete a conflict of interest declaration prior to participation. Publisher Copyright: © 2017, © 2017 World Stroke Organization.

PY - 2018/6/1

Y1 - 2018/6/1

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Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy

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