AAN Issues New Stroke Guidelines
The American Academy of Neurology has revised its 1998 guidelines on the prevention of stroke with nonvalvular atrial fibrillation (NVAF).
Researchers reviewed evidence published since 1998 concerning detection of NVAF in patients with stroke, as well as strategies for the prevention of stroke in patients with NVAF, focusing on 2 questions:
- For patients with cryptogenic stroke, how often do various technologies identify previously undetected NVAF?
- For patients with NVAF, which therapies that include antithrombotic medication, as compared with no therapy or with another therapy, reduce stroke risk and severity with the least risk of hemorrhage?
The guidelines also take into account new oral anticoagulants and their effectiveness compared with other drug-therapies, calling them “noninferior or superior to warfarin for reducing stroke.”
Major recommendations included the following:
- Clinicians should routinely offer anticoagulation to patients with NVAF and history of stroke
- Clinicians should identify patients with cryptogenic stroke and utilize outpatient monitoring studies to recognize NVAF within those patients.
- Inform patients of the dangers of internal bleeding when explaining antithrombotic therapy.
The guidelines were originally published in Neurology.
–Michael Potts
Reference
Culebras A, Messe SR, Chaturvedi S, et al. Summary of evidence-based guideline update: Prevention of stroke in nonvalvular atrial fibrillation Neurology. doi: 10.1212/WNL.0000000000000145