Stroke prevention.

Introduction: People with a history of stroke or transient ischaemic attack are at high risk of all vascular events, such as myocardial infarction (MI), but are at particular risk of subsequent stroke (about 10% in the first year and about 5% each year thereafter).
Methods and Outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions in people with previous stroke or transient ischaemic attack? What are the effects of preventive anticoagulant and antiplatelet treatments in people with atrial fibrillation and either with or without previous stroke or transient ischaemic attack? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2006 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results: We found 120 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: alternative antiplatelet regimens to aspirin, anticoagulation (oral dosing, or in those with sinus rhythm), aspirin (high-dose, or low-dose aspirin), blood pressure reduction, carotid and vertebral percutaneous transluminal angioplasty, carotid endarterectomy (in people: with asymptomatic but severe carotid artery stenosis; with less than 30% symptomatic carotid artery stenosis; with moderate [30-49%] symptomatic carotid artery stenosis; with moderately severe [50-69%] symptomatic carotid artery stenosis; with severe [more than 70%] symptomatic carotid artery stenosis; or with symptomatic near occlusion of the carotid artery), cholesterol reduction, vitamin B suppliments (including folate), or different blood pressure-lowering regimens.