J Stroke.  2022 Jan;24(1):166-175. 10.5853/jos.2021.02628.

2022 Update of the Korean Clinical Practice Guidelines for Stroke: Antithrombotic Therapy for Patients with Acute Ischemic Stroke or Transient Ischemic Attack

Affiliations
  • 1Department of Neurology, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
  • 2Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 3Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
  • 4Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
  • 5Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
  • 6Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
  • 7Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
  • 8Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
  • 9Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 10Department of Neurology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
  • 11Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 12Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 13Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 14Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea

Abstract

Antithrombotic therapy is a cornerstone of acute ischemic stroke (AIS) management and secondary stroke prevention. Since the first version of the Korean Clinical Practice Guideline (CPG) for stroke was issued in 2009, significant progress has been made in antithrombotic therapy for patients with AIS, including dual antiplatelet therapy in acute minor ischemic stroke or high-risk transient ischemic stroke and early oral anticoagulation in AIS with atrial fibrillation. The evidence is widely accepted by stroke experts and has changed clinical practice. Accordingly, the CPG Committee of the Korean Stroke Society (KSS) decided to update the Korean Stroke CPG for antithrombotic therapy for AIS. The writing members of the CPG committee of the KSS reviewed recent evidence, including clinical trials and relevant literature, and revised recommendations. A total of 35 experts were invited from the KSS to reach a consensus on the revised recommendations. The current guideline update aims to assist healthcare providers in making well-informed decisions and improving the quality of acute stroke care. However, the ultimate treatment decision should be made using a holistic approach, considering the specific medical conditions of individual patients.

Keyword

Acute ischemic stroke; Antithrombotic therapy; Guideline

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Reference

References

1. CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet. 1997; 349:1641–1649.
2. International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet. 1997; 349:1569–1581.
3. Chen ZM, Sandercock P, Pan HC, Counsell C, Collins R, Liu LS, et al. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40 000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke. 2000; 31:1240–1249.
4. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013; 369:11–19.
Article
5. Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018; 379:215–225.
Article
6. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50:e344–e418.
Article
7. Boulanger JM, Lindsay MP, Gubitz G, Smith EE, Stotts G, Foley N, et al. Canadian stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 6th edition, update 2018. Int J Stroke. 2018; 13:949–984.
Article
8. Australian clinical guidelines for stroke management. Clinical guidelines for stroke management. Chapter 3: Acute medical and surgical management. Stroke Foundation;https://informme.org.au/guidelines/clinical-guidelines-for-stroke-management. 2022. Accessed January 17, 2022.
9. Bath PM, Woodhouse LJ, Appleton JP, Beridze M, Christensen H, Dineen RA, et al. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet. 2018; 391:850–859.
10. Johnston SC, Amarenco P, Albers GW, Denison H, Easton JD, Evans SR, et al. Ticagrelor versus aspirin in acute stroke or transient ischemic attack. N Engl J Med. 2016; 375:35–43.
Article
11. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49:e46–e110.
Article
12. Klijn CJ, Paciaroni M, Berge E, Korompoki E, Kõrv J, Lal A, et al. Antithrombotic treatment for secondary prevention of stroke and other thromboembolic events in patients with stroke or transient ischemic attack and non-valvular atrial fibrillation: a European Stroke Organisation guideline. Eur Stroke J. 2019; 4:198–223.
Article
13. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al. The 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018; 39:1330–1393.
Article
14. The writing group of clinical practice guideline for stroke. Clinical Practice Guideline for Stroke. Seoul, KR: Clinical Research Center for Stroke;2009.
15. United States Department of Health and Human Services; Agency for Health Care Policy and Research. Acute Pain Management: Operative or Medical Procedures and Trauma. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research;1993. p. 107.
16. Pan Y, Elm JJ, Li H, Easton JD, Wang Y, Farrant M, et al. Outcomes associated with clopidogrel-aspirin use in minor stroke or transient ischemic attack: a pooled analysis of Clopidogrel in High-Risk Patients With Acute Non-Disabling Cerebrovascular Events (CHANCE) and Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trials. JAMA Neurol. 2019; 76:1466–1473.
17. Johnston SC, Amarenco P, Denison H, Evans SR, Himmelmann A, James S, et al. Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA. N Engl J Med. 2020; 383:207–217.
Article
18. Jeong HG, Kim BJ, Yang MH, Han MK, Bae HJ, Lee SH. Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment. Neurology. 2016; 87:996–1002.
Article
19. Lee YS, Bae HJ, Kang DW, Lee SH, Yu K, Park JM, et al. Cilostazol in Acute Ischemic Stroke Treatment (CAIST Trial): a randomized double-blind non-inferiority trial. Cerebrovasc Dis. 2011; 32:65–71.
Article
20. Adams HP Jr, Effron MB, Torner J, Dávalos A, Frayne J, Teal P, et al. Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II). Stroke. 2008; 39:87–99.
21. Zhang S, Hao Y, Tian X, Zi W, Wang H, Yang D, et al. Safety of intra-arterial tirofiban administration in ischemic stroke patients after unsuccessful mechanical thrombectomy. J Vasc Interv Radiol. 2019; 30:141–147.
Article
22. Kim YW, Sohn SI, Yoo J, Hong JH, Kim CH, Kang DH, et al. Local tirofiban infusion for remnant stenosis in large vessel occlusion: tirofiban ASSIST study. BMC Neurol. 2020; 20:284.
Article
23. Baek BH, Yoon W, Lee YY, Kim SK, Kim JT, Park MS. Intravenous tirofiban infusion after angioplasty and stenting in intracranial atherosclerotic stenosis-related stroke. Stroke. 2021; 52:1601–1608.
Article
24. Saxena R, Lewis S, Berge E, Sandercock PA, Koudstaal PJ. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the International Stroke Trial. Stroke. 2001; 32:2333–2337.
Article
25. Berge E, Abdelnoor M, Nakstad PH, Sandset PM. Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation: a double-blind randomised study. HAEST Study Group. Heparin in Acute Embolic Stroke Trial. Lancet. 2000; 355:1205–1210.
26. Paciaroni M, Agnelli G, Micheli S, Caso V. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials. Stroke. 2007; 38:423–430.
27. Whiteley WN, Adams HP Jr, Bath PM, Berge E, Sandset PM, Dennis M, et al. Targeted use of heparin, heparinoids, or low-molecular-weight heparin to improve outcome after acute ischaemic stroke: an individual patient data meta-analysis of randomised controlled trials. Lancet Neurol. 2013; 12:539–545.
Article
28. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013; 369:2093–2104.
Article
29. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365:883–891.
Article
30. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365:981–992.
31. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361:1139–1151.
Article
32. Paciaroni M, Agnelli G, Falocci N, Caso V, Becattini C, Marcheselli S, et al. Early recurrence and cerebral bleeding in patients with acute ischemic stroke and atrial fibrillation: effect of anticoagulation and its timing: the RAF Study. Stroke. 2015; 46:2175–2182.
33. Arihiro S, Todo K, Koga M, Furui E, Kinoshita N, Kimura K, et al. Three-month risk-benefit profile of anticoagulation after stroke with atrial fibrillation: the SAMURAI-Nonvalvular Atrial Fibrillation (NVAF) study. Int J Stroke. 2016; 11:565–574.
Article
34. Seiffge DJ, Traenka C, Polymeris A, Hert L, Peters N, Lyrer P, et al. Early start of DOAC after ischemic stroke: risk of intracranial hemorrhage and recurrent events. Neurology. 2016; 87:1856–1862.
35. Hong KS, Kwon SU, Lee SH, Lee JS, Kim YJ, Song TJ, et al. Rivaroxaban vs warfarin sodium in the ultra-early period after atrial fibrillation-related mild ischemic stroke: a randomized clinical trial. JAMA Neurol. 2017; 74:1206–1215.
36. Wilson D, Ambler G, Banerjee G, Shakeshaft C, Cohen H, Yousry TA, et al. Early versus late anticoagulation for ischaemic stroke associated with atrial fibrillation: multicentre cohort study. J Neurol Neurosurg Psychiatry. 2019; 90:320–325.
Article
37. Mizoguchi T, Tanaka K, Toyoda K, Yoshimura S, Itabashi R, Takagi M, et al. Early initiation of direct oral anticoagulants after onset of stroke and short- and long-term outcomes of patients with nonvalvular atrial fibrillation. Stroke. 2020; 51:883–891.
Article
38. Brook RH, Chassin MR, Fink A, Solomon DH, Kosecoff J, Park RE. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986; 2:53–63.
Article
39. Clinical research collaboration for stroke in Korea: CRCS-K statistics 2020 report. Korean Stroke Registry. http://www.Strokedb.or.kr/report/index.Asp. 2020. Accessed December 17, 2021.
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