title: Filling the gap between science & clinical practice: prevention of stroke recurrence.
abstract: Because of its high recurrence rate, active secondary prevention is mandatory once an episode of stroke has occurred. In non-cardioembolic stroke, in addition to lifestyle changes and to targeted treatments, current guidelines recommend aspirin, clopidogrel or aspirin+extended-release dipyridamole. In cardioembolic stroke (due to atrial fibrillation or flutter [AF]), vitamin K antagonists (VKAs) are recommended in most of patients. A favorable risk/benefit ratio of these treatments has been demonstrated also in elderly patients. However, registry data emphasize that such interventions are often under-used, especially in AF patients. A poor knowledge of current guidelines may play a role in hampering their application in clinical practice. The risk of major bleeding associated with antithrombotic drugs, their inherent limitations, such as socio-demographic (age >80 years, living alone) and clinical (previous or recent bleeding, trauma, cancer, dementia) features, may account for the gap between current guidelines for stroke/TIA prevention and clinical practice. The objective of the present report is to evaluate the gap between current recommendations/guidelines for stroke/TIA prevention and clinical practice (registry findings). In our opinion new antithrombotic drugs and detailed educational programs (especially devoted to general practitioners and to some medical specialists), concerning efficacy, safety and limitations of these strategies, are needed to better manage stroke epidemics in the third millennium.
authors: Department of Experimental and Clinical Medicine, and Regional Reference Centre for Coagulation Disorders, Federico II University of Naples, Italy. anna.russolillo@gmail.com
authors: Anna
authors: A
authors: Russolillo
authors: Matteo Nicola Dario
authors: MN
authors: Di Minno
authors: Antonella
authors: A
authors: Tufano
authors: Domenico
authors: D
authors: Prisco
authors: Giovanni
authors: G
authors: Di Minno
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors