Clinical trials in stroke prevention.
The randomized clinical trial has no satisfactory substitute in the evaluation of preventive treatment for stroke-threatened patients, and is the gold standard also in studies designed to test strategies which may reduce the impact of brain damage after ischemic stroke has occurred. Stroke data banks and contemporary non-randomized comparisons are imperfect or flawed as bench-marks against which to judge treatments for these types of patients. Flaws in the design, execution and analysis of randomized clinical trials have been eliminated gradually over the past 35 years. On the basis of the existing trials in stroke prevention it may be stated that anticoagulants are effective in patients with non-rheumatic atrial fibrillation and after myocardial infarction. No other uses of anticoagulants in preventing ischemic stroke have been proven. Acetylsalicylic acid between 325-1300 mg/d will prevent stroke; lower doses have not been proven of value. Ticlopidine is effective. Benefit for dipyridamole, suloctidil or sulfinpyrazone has not been shown. Cerebral by-pass surgery has not been shown to have any role in stroke prevention in arteriosclerotic cerebral vascular disease. Carotid endarterectomy is still undergoing careful evaluation.
Barnett
H J
HJ
John P. Robarts Research Institute, London, Ontario, Canada.
D002561:Cerebrovascular Disorders / Q000503:physiopathology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D006801:Humans; D012107:Research Design