Stroke: The way things really are

Abstract

Background To comply with governmental requirements regarding the validity of therapeutic modalities and for med­ico-legal purposes, it is important to distinguish between what has been scientifically proven and what is anecdotal in the prevention and management of stroke. Summary of Review This review summarizes the evidence for many of the modalities used to prevent stroke in high-risk patients, including antiplatelet drugs, anticoagulants, and endarterectomy, and the limitations of each. Controversial thera­peutic modalities for which no scientific proof exists, such as anticoagulation of progressing stroke, are also discussed. The term “standard of care” should apply to modalities proven to be effective by scientifically controlled studies, not because they are used by many physicians. Treatment of acute stroke is still disappointing despite the development of many promising pharmacological strategies in experimental animals. An important part of the reason may be that the window of therapeutic opportunity is much shorter than the usual entry time of patients in most clinical trials. This logistic problem merits serious attention. Conclusions Numerous controlled, randomized, multiple-center clinical trials have demonstrated that the efficacy or lack thereof of various therapies directed at preventing or treating stroke can be determined and that anecdotal data may be misleading and harmful. At the least we should be aware of what we know and what we do not. © 1994 American Heart Association, Inc.