national-clinical-guidelines-for-stroke-fourth-edition

Recommendations

Info

5.8.6.2 Sources A Consensus; De Schryver et al 2006; Ringleb et al 2004; National Institute for Health and Clinical Excellence 2008b 5.9 Oral contraception Primary prevention studies indicate that there may be an approximate doubling of the relative risk of ischaemic stroke in women using combined (low-dose) oestrogen oral contraception. This equates to a very small increase in the absolute risk of one ischaemic stroke per year per 20,000 women using low-dose oestrogen oral contraception. It is unclear how this risk is influenced by a prior history of TIA or stroke. There is limited evidence from primary prevention studies that contraceptive methods containing progesterone (oral, implant and injectable) showed no significant increase in the risk of stroke and can be used if oral contraception is necessary. For every woman who has had a stroke the risks of pregnancy need to be weighed up against the risks associated with the use of contraception. The full range of contraceptive methods (hormonal and nonhormonal) should be considered when making a decision. Evidence to recommendation There is strong evidence from primary prevention studies that there is a risk of stroke associated with the use of oestrogen containing contraception (Faculty of Sexual and Reproductive Health 2009). The increased risk is mainly for ischaemic stroke. There is limited evidence from a meta-analysis of primary prevention studies (Chakhtoura et al 2009) that progesterone-only methods of contraception appear to have no significant increase in risk of stroke (ischaemic and haemorrhagic). Due to variation in the design and populations included in the studies, it is difficult to compare the risk associated with different modes of delivery of progesterone (oral, injectable and implant) and make any recommendations. There are no studies looking at the safety of the progesterone containing intra-uterine system. There is no evidence on the risk of stroke associated with use of higher doses of progesterone in the treatment of menstrual disorders but if oral contraception is required, there is limited evidence that progesterone-only contraceptives appear to have the least risk. 5.9.1 Recommendation 5.9.2 Source A The combined oral contraceptive pill should not be routinely prescribed following ischaemic stroke. A Faculty of Sexual and Reproductive Health 2009 5.10 Hormone replacement therapy 5 Secondary prevention Some women who have had a stroke may wish to continue with hormone replacement therapy treatment for control of symptoms and an enhanced quality of life. © Royal College of Physicians 2012 77
National clinical guideline for stroke Evidence to recommendation There is strong evidence from a meta-analysis (Farquhar et al 2009) of an increased risk of stroke with the use of oestrogen-only and combined (oestrogen and progesterone) hormone replacement therapy in relatively healthy women. Giving hormone therapy must be balanced against clinical need (treatment of premature menopause or relief of menopausal symptoms). There is limited evidence from one case control study (Renoux et al 2010) that transdermal hormone replacement therapy may not be associated with an increased risk of stroke and that lower doses of oestrogen have a lower risk of stroke. One study looking at tibolone (Cummings et al 2008) was ended prematurely due to an increased risk of stroke. Tibolone is not recommended in the use of treatment of menopausal-related symptoms or treatment of osteoporosis in women who have had a stroke. 5.10.1 Recommendation 5.10.2 Source A The decision whether to start or continue hormone replacement therapy should be discussed with the individual patient and based on an overall assessment of risk and benefit. Consideration should be given to the dosage and formulation (eg oral or transdermal preparations). A Magliano et al 2006 78 © Royal College of Physicians 2012
Page 1 and 2:
National clinical guideline for str
Page 3 and 4:
The Royal College of Physicians The
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
The Intercollegiate Stroke Working
Page 11 and 12:
Conflicts of interest All working p
Page 13 and 14:
Key recommendations Number Recommen
Page 15 and 16:
Page 17 and 18:
Acknowledgements The Intercollegiat
Page 19 and 20:
Glossary ABCD2 score Prognostic sco
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 36 and 37:
2 Commissioning of stroke services
Page 38 and 39:
2.1.2 Implications needed by patien
Page 40 and 41:
2.4 Commissioning rehabilitation se
Page 42 and 43:
3 Organisation of stroke services 3
Page 44 and 45:
symptoms who screen positive using
Page 46 and 47:
● nursing staff specifically trai
Page 48 and 49:
3.5.1 Recommendation 3.5.2 Source A
Page 50 and 51: 3.8 Transfers of care - discharge f
Page 52 and 53: B Clinicians in all settings should
Page 54 and 55: E have protocols to guide the use o
Page 56 and 57: Evidence to recommendations It is r
Page 58 and 59: evidence from randomised trials is
Page 60 and 61: 4 Acute phase care 4.0 Introduction
Page 62 and 63: E All patients with residual neurol
Page 64 and 65: esources to respond to the need. Pr
Page 66 and 67: D People with an acute non-disablin
Page 68 and 69: D Consensus; quality marker eight o
Page 70 and 71: [K] Any person with acute ischaemic
Page 72 and 73: prevent rebleeding are urgent. CT s
Page 74 and 75: anticoagulants including direct thr
Page 76 and 77: Evidence to recommendations Studies
Page 78 and 79: ● risk of developing skin pressur
Page 80 and 81: 4.16 Positioning Impairment of moto
Page 82: section covers only the immediate,
Page 85 and 86: National clinical guideline for str
Page 99: National clinical guideline for str
Page 148 and 149: 7 Long-term management 7.0 Introduc
Page 150 and 151:
● where appropriate refer the per
Page 152 and 153:
experience appropriate to meet thei
Page 154 and 155:
Profession-specific concise guideli
Page 156 and 157:
● ensure that all relevant inform
Page 158 and 159:
C People with stroke should be offe
Page 160 and 161:
● avoiding the use of overhead ar
Page 162 and 163:
Carers (informal, unpaid) (7.6.1) A
Page 164 and 165:
● any continuing specialist treat
Page 166 and 167:
Lipid-lowering therapy (5.6.1) B Al
Page 168 and 169:
Occupational therapy concise guide
Page 170 and 171:
C Bilateral arm training involving
Page 172 and 173:
● be referred to a specialist in
Page 174 and 175:
problems, such as using notebooks,
Page 176 and 177:
Physiotherapy concise guide for str
Page 178 and 179:
medically unstable, by an appropria
Page 180 and 181:
numerical rating scale), the modifi
Page 182 and 183:
Cognitive impairments - general (6.
Page 184 and 185:
E Patients with suspected TIA who a
Page 186 and 187:
Lipid-lowering therapy (5.6.1) A Al
Page 188 and 189:
● ask about and identify any abso
Page 190 and 191:
formal review at least every 6 mont
Page 192 and 193:
Depression and anxiety (6.35.1) A A
Page 194 and 195:
Perception (6.42.1) A Any person wh
Page 196 and 197:
days per week, at a level that enab
Page 198 and 199:
language function should be assesse
Page 200:
● organising and supporting venue
Page 204 and 205:
Appendix 1 Evidence table reviewers
Page 206 and 207:
Appendix 2 Peer reviewers Commissio
Page 208 and 209:
Dr Katerina Hilari City University
Page 210 and 211:
QM7 Urgent response All patients wi
Page 212 and 213:
References Abbott AL (2009) Medical
Page 214 and 215:
Cirstea MC, Levin MF (2007) Improve
Page 216 and 217:
Fung TT, Chiuve SE, McCullough ML,
Page 218 and 219:
Koyuncu E, Nakipoglu YG, Dogan A, O
Page 220 and 221:
Mitchell PH, Veith RC, Becker KJ, B
Page 222 and 223:
Rothwell P, Eliasziw M, Gutnikov S,
Page 224:
therapy for stroke inpatients. Clin
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
show all

national-clinical-guidelines-for-stroke-fourth-edition

Create successful ePaper yourself

Delete template?

Save as template?