Resumen
The 2020 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for the Secondary Prevention of Stroke includes current evidence-based recommendations and expert opinions intended for use by clinicians across a broad range of settings. They provide guidance for the prevention of ischemic stroke recurrence through the identification and management of modifiable vascular risk factors. Recommendations address triage, diagnostic testing, lifestyle behaviors, vaping, hypertension, hyperlipidemia, diabetes, atrial fibrillation, other cardiac conditions, antiplatelet and anticoagulant therapies, and carotid and vertebral artery disease. This update of the previous 2017 guideline contains several new or revised recommendations. Recommendations regarding triage and initial assessment of acute TIA and minor stroke have been simplified, and selected aspects of the etiological stroke workup are revised. Updated 91 treatment recommendations based on new evidence have been made for dual antiplatelet therapy for TIA and minor stroke; anticoagulant therapy for atrial fibrillation; embolic strokes of undetermined source; LDL lowering; hypertriglyceridemia; diabetes treatment; and PFO management. A new section has been added to provide practical guidance regarding temporary interruption of antithrombotic therapy for surgical procedures. Cancer-associated ischemic stroke is addressed. A section on virtual care delivery of secondary stroke prevention services in included to highlight a shifting paradigm of care delivery made more urgent by the global pandemic. Additionally, where appropriate, sex differences as they pertain to treatments have been addressed. The CSBPR include supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.
| Idioma original | English |
|---|---|
| Publicación | Canadian Journal of Neurological Sciences |
| DOI | |
| Estado | Accepted/In press - 2021 |
Nota bibliográfica
Funding Information:The following authors have identified actual or potential conflicts of interest which have been mitigated through the design of a multidisciplinary writing group model and additional measures by the advisory committee as required. David J. Gladstone received a Mid-Career Investigator Award from the Heart and Stroke Foundation, a peer-reviewed provincial operating grant from Ontario Genomics; all funds paid to his institution to support the project (no personal fees); Independent Medical Safety Monitor for the NINDS-sponsored ARCADIA trial (uncompensated), and local site PI for the NASPAF-ICH and
Funding Information:
ENRICH-AF trials (with all site fees paid to his institution; no personal fees); served as PI of the SCREEN-AF trial (uncompensated); operating grant from the Canadian Stroke Prevention Intervention Network (C-SPIN), a peer-reviewed Canadian Institutes of Health Research [CIHR]) national network grant; Adjudication Committee SAFE-HD trial (uncompensated); and is the Site Investigator for NAVIGATE ESUS trial and NASPAF-ICH trial (all site fees paid to my institution); co-leader of NAVIGATE ESUS atrial myopathy/atrial fibrillation working group (uncompensated). Alexandre Y. Poppe is Site PI and Site co-investigator for ESCAPE-NA1 (NoNo), NAVIGATE-ESUS (Bayer), RESPECT-ESUS (Boehringer-Ingelheim), POINT (NIH); DSMB for FLOW; Canadian Stroke Trials for Optimized Results (CaSTOR) networking grant; Chair, Canadian Stroke Consortium National Stroke Fellowship Program; receives support for fellowship program from Servier; and research grant support from Stryker. Jafna Cox is a Medical Consultant (received payment) for Bayer, HLS Therapeutics, Novartis; Lecture Series (received payment) with Bayer; holds an Investigator-initiated grant from Bayer; and participating in a Phase II study of a Factor XI inhibitor, funded by Bayer. James Douketis is an Advisory Board Consultant for BMS Pfizer, Servier, Leo Pharma, Sanofi, Bayer; holds a grant/Honorarium from Thrombosis Canada (non-profit); participation in PAUSE trial. Monies received as personal fees from Janssen, Pfizer, Bayer, Bristol Myers Squibb, Sanofi, Servier Canada, Portola are deposited in hospital-based (St. Joseph’s Healthcare Hamilton) and university-based (McMaster University) research accounts and/or charitable foundations. Brett R. Graham holds a Canadian Stroke Consortium Catalytic Research Capacity Generation Grant; is site PI University of British Columbia, University of Calgary - SECRET and TOPSECRET; site sub-I for TEMPO-2 an ESCAPE NA1. Honorarium received from Servier Canada (to give a talk on anticoagulation in afib to family physicians. Marilyn Labrie is an advisory board member for Teva Canada – Fremanezumab 2020–08–23. Jennifer Mandzia is an advisory board with Bayer; and is clinical trial Site PI for several studies. Daniel Ngui is a member of the Advisory Board for Amgen, Astra Zeneca, BMS, BI, Lilly, Novonordisk; moderating and speaking engagements for Amgen, Astra Zeneca, BMS, BI, Lilly, Novonordisk; EMR grants and audits for Amgen, Astra Zeneca, BI, Novartis; holds research grants from Simple Trial, Amgen 20170191 trial, IHE eCare CV Risk, CHRC EMR Registry Trials: AF OAC, Advantage CV, and Advantage OP-Phase 4 and EMR audits; Health Choices First Video Education shares; Investments in communications companies including CHRC, CCRN, MD Briefcase, Medplan, Liv Agency, Four Health; board membership on CCS Lipid guideline Panel, CCS A. fib guideline second panel, SPH Hospital CME Committee, BC Guidelines, UBC CPD CME “This changed my practice,” Alliance for Best Practices in Health Education. William Semchuk is an Advisory Board Member for BMS Pfizer; Speaker Honorarium from BMS, Pfizer, Astra Zeneca, Sanofi, Servier, Bayer, BI. Jacob A Udell is an advisory board member for Boehringer Ingelheim, Novartis, Sanofi; Secondary analysis of banked biospecimens from a completed RCT for Janssen; Consultant on clinical research development, (no involvement in marketing) with Boehringer Ingelheim, Janssen, Sanofi, Amgen, Merck, Novartis; received grant to University Health Network for clinical trial from Astra-Zeneca; grant to University Health Network for clinical trial and honorarium for leadership of a multicenter RCT from Boehringer Ingelheim; grant to Women’s College Hospital for clinical research study from Janssen; grant to Women’s College Hospital to be a site in a multicenter RCT and honorarium for steering committee membership in cohort study by Novartis; grant to Women’s College Hospital for site participation in a multicenter RCT and honorarium for national co-PI role in multicenter RCT for Sanofi; grants to his institutions for clinical trial participation from Boehringer Ingelheim, Novartis, Sanofi; grant from Bayer. Stephen van Gaal is a site investigator who enrolls patients for Portola, Bayer; advisory board member for Servier (edoxaban); support for conference attendance from Bayer (rivaroxaban); Canadian Stroke Consortium committee member. Karina Villa-luna is a Clinical Research Coordinator participating in research for NoNO Inc, Portola and BMS. Eric E. Smith participates in consulting for clinical trials in cerebral amyloid angiopathy, vascular cognitive impairment, and preventing atrial fibrillation-related stroke with Bayer, Biogen, Javelin; Royalties from UpToDate for chapter on diagnosing vascular dementia; and is Study site for Biogen study on adacanumab for Alzheimer’s disease. Dar Dowlatshahi holds a Heart & Stroke Foundation of Canada Research Grant and Salary Award; a Patent for CARL for detection of contrast extravasation; and is involved in several funded clinical trials; member, Canadian Stroke Consortium board of directors. Theodore Wein is a consultant for Servier, Allergan Inc, Ipsen Inc; a speaker for Servier; receives research funding from Allergan and Servier; and is PI on a Servier funded study. Shelagh Coutts holds a current CIHR grant. Gord Gubitz is an Advisory Board member for Bayer, BI, Pfizer; Member, DSMB CATIS-ICAD trial; Member, Steering Committee. HSF Canada Stroke Best Practices; Co-Chair, World Stroke Organization Education Committee; Atlantic Canada Together Enhancing Acute Stroke Treatment (ACTEAST): Improving Access and Efficiency of Treatment. Co-Investigator. Canadian Institutes of Health Research (CIHR) Project Grant; Optimization and Validation of a Novel Emergency Department Point-of-Care MRI. Nova Scotia Health Research Foundation. Research Nova Scotia Trust, Industry collaborator; the effects of prism adaptation training on visual attention and functional activities in stroke patients with neglect. Nova Scotia Health Research Foundation – Establishment Grant. Paul Pageau is a past board member, Canadian Association of Emergency Physicians. The following authors have no conflicts of interest to declare: M. Patrice Lindsay, Anita Mountain, Aline Bourgoin, John B. Falconer, Norine Foley, Lena McDonald, Rebecca McGuff, Amanda Rod-gerson, Tammy Tebbutt, and Carmen Tuchak.
Publisher Copyright:
© 2021 Cambridge University Press. All rights reserved.
ASJC Scopus Subject Areas
- Neurology
- Clinical Neurology
PubMed: MeSH publication types
- Journal Article
- Review
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