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Prevention Of Stroke

6th Edition
2017 UPDATED - October 2017

Secondary Prevention of Stroke Update 2017 Module Overview

This Secondary Prevention of Stroke module focuses on management recurrent stroke risk reduction in patients who have experienced an initial stroke or transient ischemic attack.  In some cases, this module will also guide healthcare providers with guidance for individuals at high risk of a stroke or TIA based on current health status and the significant presence of one or more vascular risk factors.

Notable Updates in CSBPR Secondary Prevention of Stroke 2017

The 2017 update of the Canadian Stroke Best Practice Recommendations Secondary Prevention of Stroke module reinforces the growing and changing body of research evidence available to guide stroke prevention services. A coordinated and organized approach to assessment and aggressive risk factor management is emphasized throughout this module.

Highlights of significant updates and new additions to the Secondary Prevention of Stroke best practice recommendations for 2017 that are based on new and emerging evidence include:

  • addition of a framework for providing stroke prevention services, and a detailed list of care elements that should be included to distinguish stroke prevention services;
  • revisions to the recommendations for the triage and assessment of risk of recurrent stroke after TIA/minor stroke and suggested urgency levels for investigations and initiation of management strategies (Section 1);
  • smoking cessation has been added to the lifestyle section rather than a separate section  (Section 2);
  • minor updates to blood pressure management, lipid management and diabetes and stroke sections to reflect recent clinical trial releases and guideline updates by the respective medical societies (Sections 3, 4, 5 respectively);
  • refinements to stroke prevention and management of atrial fibrillation and anticoagulant use (Section 7);
  • clarifications on  timing for carotid interventions (Section 8);
  • antithrombotic management in people with cervicocephalic artery dissection
  • With the recent completion of the REDUCE and CLOSE trials, and long-term follow-up from the RESPECT trial, the recommendations for people with patent foramen ovale have been updated (Section 9).
  • Heart failure has been added to the Cardic Issues section (Section 9)
  • updates to Heart and Stroke Taking Charge patient information on best practices related to stroke prevention http://www.strokebestpractices.ca/wp-content/uploads/2014/08/HSF_SBP_PatientsGuide_F14_EN_July2014-FINAL.pdf;
  • updates to Heart and Stroke public information on risk factors for heart disease and stroke http://www.heartandstroke.ca/-/media/pdf-files/iavc/health-information-catalogue/en-are-you-at-risk.ashx?la=en&hash=91D622380B55E55ADB31E7ECE37C9F51BCD26D97;
  • updates to the HSF Stroke Assessment and Prevention Pocket Guide to align with all updates to the recommendations in this module http://www.strokebestpractices.ca/wp-content/uploads/2017/07/002-17_CSBP_StrokeAssessPocketGuide_7.5×4.25_EN_v6_LR.pdf;
  • Sleep Apnea and Stroke Prevention: Sleep apnea is a recognized risk factor for stroke, and a condition that appears in some patients both before and following a stroke. However, the recently released findings of the SAVE trial (2016) has demonstrated that although treatment with CPAP of moderate-to-severe sleep apnea in patients with a history of coronary and cerebrovascular disease is associated with benefits including reduced daytime sleepiness and improved health-related quality of life, there is insufficient evidence to recommend CPAP for secondary stroke prevention, and we do not recommend routine screening of patients with stroke for OSA. In light of the SAVE results, sleep apnea screening and treatment are no longer routinely recommended for secondary prevention of stroke and accordingly have removed recommendations for universal screening and treatment in stroke patients. Screening and treatment for sleep apnea symptoms should be performed as part of routine primary care based on the presence or absence of sleep apnea symptoms, as is currently done for patients without stroke.

Secondary Prevention of Stroke Module Contents:

Secondary Prevention of Stroke guideline publication in the International Journal of Stroke

Core Elements of Delivery of Stroke Prevention Services


Citing the Prevention of Stroke 2017 Module

Theodore Wein, M. Patrice Lindsay, Robert Cote, … David Gladstone et al, on behalf of the Secondary Prevention of Stroke Writing Group.  Secondary Prevention of Stroke Module Update 2017.  In Lindsay MP, Gubitz G, Dowlatshahi D, Harrison E, and Smith EE  (Editors) on behalf of the Canadian Stroke Best Practices Advisory Committee.  Canadian Stroke Best Practice Recommendations, 2017; Ottawa, Ontario Canada: Heart and Stroke Foundation.


We invite comments, suggestions, and inquiries on the development and application of the Canadian Stroke Best Practice Recommendations.

Please forward comments to the Heart and Stroke Foundation’s Stroke Team at strokebestpractices@hsf.ca