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Of each group,>90%responded to the survey.Nearly all respondents reported prescribing aspirin in patients at risk of atherothrombotic stroke,but significant differences between NA and WE are shown by the recommended doses(P<.0001):aspirin doses of>500 mg daily are given exclusively by American participants(36%),whereas doses<200 mg are recommended only in Europe(51%).Eight-six percent of American versus 59%of European respondents reported using ticlopidine as their second choice(P<.005),and 23%of respondents from WE used warfarin compared with 5%from NA(P<.05).The reported use of anticoagulants in patients with atrial fibrillation increased in accordance with the patient's individual risk of stroke,but respondents from WE were more reluctant to use anticoagulants in patients older than 75 years.Relatively higher target international normalized ratio values were reported by European respondents.Nearly all participants recommend carotid endarterectomy in patients with symptomatic carotid stenosis.The use of a carotid endarterectomy in asymptomatic patients was significantly more common among responding experts from NA(48%versus 29%; P>.05),particularly in patients with>95%stenosis(89%versus 53%,P<.0005). This analysis shows significant differences in several areas of stroke prevention practices between leading experts from NA and WE.These differences may be explained partly by divergent results of trials from the two continents,but in some areas of controversy currently available trial data are not sufficient to form an international consensus to guide daily clinical practice. |
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anticoagulant,treatment
anticoagulant,treatment in CVD
aspirin
cerebrovascular accident
cerebrovascular accident,surgical treatment of
controversies in neurology
coumarin
endarterectomy,carotid
treatment of neurologic disorder
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