Preventing a second stroke: 18 organizations develop optimal preventative care for stroke patients

04.03.2015 19:13

The new S3 guideline „Secondary prophylaxis of ischemic stroke and transient ischemic attack – Part 1“ summarizes the latest findings on protection against a recurrent stroke.

Every year in Germany, 270,000 people suffer a stroke for the first time or experience a recurrent stroke. While the number of survivors is steadily increasing, the risk of another stroke rises significantly after the first: 10 percent of these patients suffer another stroke within the same year. Targeted prevention can reduce these risk factors. For this reason, the German Society for Neurology (DGN) and the German Stroke Society (DSG) spearheaded the development of the first S3 guideline, "Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack." The first part of this guideline has now been published on the guideline platforms of the DGN (www.dgn.org) and the Association of Scientific Medical Societies (www.awmf.org).

In addition to the German Society of Neurology (DGN) and the German Stroke Society (DSG), 16 other medical societies, professional associations, and other organizations co-adopted the guideline. Methodological support was provided by the Center for Stroke Research Berlin (CSB) at Charité. Prof. Dr. Matthias Endres of Charité, a member of the four-person guideline steering committee, explains: „This guideline summarizes the current findings and gives treating physicians clear recommendations. This is essential to preventing as many patients as possible in Germany from suffering another stroke.“

Ischemic stroke and TIA

An ischemic stroke occurs when a blood clot blocks a brain artery – the most common cause of stroke. A transient ischemic attack (TIA) is a milder form. It lasts only seconds or minutes, and the symptoms resolve completely. However, a TIA is considered a precursor and warning sign of an impending ischemic stroke. These patients must therefore be examined, and stroke prevention measures may need to be initiated.

Elaborate processes for the best recommendation – without influence from special interests.

Guidelines are recommendations from physicians and scientists specializing in a particular field for their medical colleagues. S3 guidelines are of the highest quality because they are developed through a complex process involving many experts and organizations, resulting in a high degree of substantive certainty – the risk of individual interests, whether conscious or unconscious, prevailing is significantly minimized by the highly regulated decision-making structures.

The new S3 guideline on secondary prevention of ischemic strokes was developed using a structured two-stage process: First, the latest scientific findings were evaluated by experts, and treatment recommendations were derived from them. More than 4,500 scientific publications were reviewed for this purpose. This was followed by a formal consensus-building process among the participating professional societies, associations, and organizations, ensuring the broadest possible interdisciplinary consensus for all recommendations in this S3 guideline. To ensure maximum transparency throughout the entire development process, the individual steps were documented in a detailed methods report. This report is also available on the DGN and AWMF websites.

Guideline in two parts

The newly published Part 1 of the guideline addresses the most important therapeutic approaches for stroke prevention: the use of antiplatelet agents, the treatment of hyperlipidemia, oral anticoagulation in atrial fibrillation, and the treatment of arterial hypertension. Part 2 of the S3 guideline is currently under development: it will cover eight further topics in secondary stroke prevention, such as lifestyle changes to reduce risk. Once both parts of the guideline are published, a version for patients and their families will also be released, summarizing the content of the S3 guideline in layman's terms.

The importance of guidelines

The recommendations of this S3 guideline are not legally binding, unlike laws. They must be considered in the context of each individual patient's situation and modified by the treating physician if necessary. Guidelines play a crucial role in ensuring comprehensive quality assurance in medicine.