An assessment of guidelines for prevention of ischemic stroke

Objective: To compare methods and key management recommendations from recent stroke prevention guidelines. Methods: Systematic review of guidelines for prevention of ischemic stroke published in English between 1996 and 2001 was conducted, and recommendations were independently abstracted and compared. Results: Among 22 stroke prevention guidelines, information was provided about panel selection in 24%, funding source in 36%, consensus methods in 33%, and quantitative risk/benefit estimates in 38%. Eleven recommended anticoagulation for patients with atrial fibrillation at high risk for stroke, but eight different sets of criteria to identify high-risk patients were proposed. Recommendations regarding carotid endarterectomy for asymptomatic stenosis varied from general endorsement in a setting of low perioperative risk to routinely withholding surgery. All nine relevant guidelines endorsed aspirin in dosages between 50 and 325 mg/day for initial antiplatelet therapy following cerebral ischemia; six also suggested other antiplatelet agents as options for initial therapy. Conclusions: Current stroke prevention guidelines do not provide adequate methodologic information to permit assessment of their quality, potential bias, and clinical applicability. Management recommendations are relatively consistent but differ in several important areas.