With an increasing incidence rate, ischemic stroke has become a major public health problem. Early and effective secondary prevention is a key strategy for reducing its high morbidity, high recurrence and high mortality. Combined with the clinical phenotypes and imaging features, the application of potential blood biomarkers can provide the scientific basis for early screening and treatment monitoring to assess stroke recurrence risk stratification, then guide individualized secondary prevention. This article describes and analyzes the current clinical application, existing challenge, and the future development model of blood biomarkers in the field of secondary stroke prevention.
Biomarkers ; Humans ; Incidence ; Ischemic Stroke ; Secondary Prevention ; Stroke/prevention & control*

China ; Humans ; Risk Factors ; Stroke/prevention & control*

BACKGROUND AND PURPOSE: Clinical practice guidelines (CPGs) are regarded as an essential guidance tool for practicing physicians. We surveyed physicians in Korea in order to evaluate their attitudes toward the Korean CPGs for stroke. METHODS: We obtained participation agreement for our survey from 27 centers of the 33 most actively contributing to the Korean Stroke Registry. A total of 174 neurologists participated in a questionnaire interview regarding their attitudes toward CPGs for stroke. RESULTS: Of 174 participating neurologists, 65 (37.4%) were stroke neurologists. The average age was 33.6+/-7.1 and 49 (28.2%) were female. Most of the respondents held positive attitudes and opinions regarding the use of the guidelines, whereas only a small percentage (14.9%) responded negatively. More than 60% of the physicians in the survey reported adherence to the Korean CPGs in dyslipidemia management for the secondary prevention of stroke. CONCLUSIONS: The positive attitudes and opinions toward the guidelines imply that physicians' attitudes should not be regarded as a potential barrier to the implementation of Korean CPGs for stroke practiced by general physicians.
Surveys and Questionnaires ; Dyslipidemias ; Female ; Humans ; Korea ; Secondary Prevention ; Stroke*

The aim of this update of Korean clinical practice guidelines for stroke is to provide timely evidence-based recommendations on the antiplatelet therapy in secondary prevention of stroke. Evidence-based recommendations are included for the use of antiplatelet agents for noncardioembolic stroke. Changes in the guidelines necessitated by new evidence will be continuously reflected in the new guideline.
Aspirin ; Platelet Aggregation Inhibitors ; Secondary Prevention ; Stroke ; Ticlopidine

The first edition of the Korean clinical practice guidelines for primary stroke prevention reflects evidence published before June 2007. Since then, several clinical studies and meta-analyses have been conducted to determine the efficacy of aspirin for the primary prevention of cardiovascular disease including stroke. The aim of this guideline update is to provide timely recommendations taking into consideration the new evidence. Three clinical studies and four meta-analyses performed between July 2007 and November 2010 were identified and included for updating the guidelines. The main finding was a lack of aspirin efficacy for primary stroke prevention in patients with diabetes or peripheral arterial disease. We have summarized the new evidence and revised our recommendations for aspirin for primary stroke prevention. New evidence will need to be reflected continuously in future guideline updates.
Aspirin ; Cardiovascular Diseases ; Humans ; Peripheral Arterial Disease ; Primary Prevention ; Stroke

OBJECTIVES: This study aimed to explore the persistence and adherence to secondary preventive medication of stroke patients after discharge and to assess the reasons for persistence and nonadherence. METHODS: Four hundred twenty-nine patients with stroke were surveyed to determine their behaviors from discharge. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications according to health care provider instructions. RESULTS: Of the 429 patients, 86.5% were treatment persistent and 41.2%(non-intentional nonadherence=39.4%, intentional nonadherence=19.4%) were adherent. Independent predictors of persistence included having experience about health education. Independent predictors of non-intentional nonadherence were modified Rankin Scale(mRS) (Exp(B)=2.858, p=0.001) and health education experience (Exp(B)=0.472, p=0.032), and independent predictors of intentional nonadherence were mRS (Exp(B)=2.533, p=0.006), depressive symptoms (Exp(B)=1.113, p=0.016), beliefs about medications questionnaire(necessity, Exp(B)=0.879, p=0.011, concern, Exp(B)=1.098, p=0.019). CONCLUSIONS: Although up to one-ninth of stroke patients continued secondary prevention medications, nonadherence is common. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions. Specially, interventions to improve adherence should target patients' beliefs about their medication.
Depression ; Health Education ; Health Personnel ; Humans ; Secondary Prevention ; Stroke*

Atrial Fibrillation/complications* ; Humans ; Singapore ; Stroke/prevention & control* ; Thailand

Due to the immature development of temperature regulation in the central nervous system, children have a weakened ability to regulate heat and are susceptible to heatstroke, which can lead to organ damage. Based on the evidence evaluation criteria of the Oxford Centre for Evidence-Based Medicine, this expert consensus group evaluated the current evidence on heatstroke in children, and formed this consensus through thorough discussion with the aim of providing reference for the prevention and treatment of heatstroke in children. This consensus includes classifications, pathogenesis, prevention measures, as well as pre-hospital and in-hospital treatment plans for heatstroke in children.
Child ; Humans ; Consensus ; Heat Stroke/prevention & control* ; Hospitals

OBJECTIVE: To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding. METHODS: A total of 23 Chinese medical centers participated in this trial. Adult patients with a history of ischemic stroke were randomly assigned in a 1:1 ratio using a block design to receive either Naoxintong Capsule (1.2 g orally, twice a day) or placebo in addition to standard care. The primary endpoint was recurrence of ischemic stroke within 2 years. Secondary outcomes included myocardial infarction, death due to recurrent ischemic stroke, and all-cause mortality. The safety of drugs was monitored. Results were analyzed using the intention-to-treat principle. RESULTS: A total of 2,200 patients were enrolled from March 2015 to March 2016, of whom 143 and 158 in the Naoxintong and placebo groups were lost to follow-up, respectively. Compared with the placebo group, the recurrence rate of ischemic stroke within 2 years was significantly lower in the Naoxintong group [6.5% vs. 9.5%, hazard ratio (HR): 0.665, 95% confidence interval (CI): 0.492-0.899, P=0.008]. The two groups showed no significant differences in the secondary outcomes and safety, including rates of severe hemorrhage, cerebral hemorrhage and subarachnoid hemorrhage (P>0.05). CONCLUSION The combination of Naoxintong Capsule with standard care reduced the 2-year stroke recurrence rate in patients with ischemic stroke without increasing the risk of severe hemorrhage in high-risk patients. (Trial registration No. NCT02334969).
Adult ; Humans ; Secondary Prevention/methods* ; Ischemic Stroke ; Stroke/prevention & control* ; Cerebral Hemorrhage/complications* ; Double-Blind Method ; Platelet Aggregation Inhibitors

Aspirin is well known for its central role in preventing cardio cerebrovascular diseases as an antiplatelet agent. However besides its favorable effects, one must also be fully aware of its side effects such as gastrointestinal complications or cerebral hemorrhage. Particularly when prescribing to Koreans, one must be highly cautious, considering the higher prevalence of helicobacter pylori infection and the contribution of hemorrhagic stroke as a major part of cerebral disease in Korean. Currently the guideline for secondary prevention of cardio cerebrovascular diseases is relatively well established, while the consensus for primary prevention is still controversial. The purpose of this paper would be to summarize the evidence of aspirin usage in preventing cardio cerebrovascular diseases, examine the additional factors one must consider, and help primary physician prescribing aspirin appropriately.
Aspirin ; Cerebral Hemorrhage ; Consensus ; Helicobacter pylori ; Prevalence ; Primary Prevention ; Secondary Prevention ; Stroke