Departments of Neurology, Erasmus University Medical Center (M.J.H.L.M., T.Y.C., D.W.J.D.), Rotterdam, The Netherlands.
Sint Franciscus Gasthuis (T.Y.C.), Rotterdam, The Netherlands.
Circulation. 2024 Sep 3;150(10):806-815. doi: 10.1161/CIRCULATIONAHA.124.069651.
Guidelines help to facilitate treatment decisions based on available evidence, and also to provide recommendations in areas of uncertainty. In this paper, we compare the recommendations for stroke workup and secondary prevention of ischemic stroke and transient ischemic attack of the American Heart Association (AHA)/American Stroke Association (ASA) with the European Stroke Organization (ESO) guidelines. The primary aim of this paper is to offer clinicians guidance by identifying areas where there is consensus and where consensus is lacking, in the absence or presence of high-level evidence. We compared AHA/ASA with the ESO guideline recommendations for 7 different topics related to diagnostic stroke workup and secondary prevention. We categorized the recommendations based on class and level of evidence to determine whether there were relevant differences in the ratings of evidence that the guidelines used for its recommendations. Finally, we summarized major topics of agreement and disagreement, while also prominent knowledge gaps were identified. In total, we found 63 ESO and 82 AHA/ASA recommendations, of which 38 were on the same subject. Most recommendations are largely similar, but not all are based on high-level evidence. For many recommendations, AHA/ASA and ESO assigned different levels of evidence. For the 10 recommendations with evidence (high quality) in AHA/ASA, ESO only labeled 4 of these as . There are many remaining issues with either no or insufficient evidence, and some topics that are not covered by both guidelines. Most ESO and AHA/ASA Guideline recommendations for stroke workup and secondary prevention were similar. However not all were based on high-level evidence and the appointed level of evidence often differed. Clinicians should not blindly follow all guideline recommendations; the accompanying level of evidence informs which recommendations are based on robust evidence. Topics with lower levels of evidence, or those with recommendations that disagree or are missing, may be an incentive for further clinical research.
指南有助于根据现有证据做出治疗决策，并为不确定领域提供建议。在本文中，我们比较了美国心脏协会（AHA）/美国卒中协会（ASA）和欧洲卒中组织（ESO）指南中缺血性卒中和短暂性脑缺血发作的卒中检查和二级预防建议。本文的主要目的是通过确定共识和缺乏共识的领域，为临床医生提供指导，在缺乏或存在高级别证据的情况下。我们比较了 AHA/ASA 与 ESO 指南建议 7 个不同主题相关的诊断性卒中检查和二级预防。我们根据类别和证据水平对建议进行分类，以确定指南用于其建议的证据评级是否存在相关差异。最后，我们总结了主要的一致和不一致的主题，同时也确定了明显的知识差距。总共发现了 63 项 ESO 和 82 项 AHA/ASA 建议，其中 38 项是相同的主题。大多数建议非常相似，但并非所有建议都基于高级别证据。对于许多建议，AHA/ASA 和 ESO 分配了不同级别的证据。在 AHA/ASA 有 证据（高质量）的 10 项建议中，ESO 仅将其中 4 项标记为 。对于许多建议，仍然存在没有或证据不足的问题，并且有些主题两个指南都没有涵盖。大多数 ESO 和 AHA/ASA 指南建议对卒中检查和二级预防是相似的。然而，并非所有建议都基于高级别证据，指定的证据级别往往不同。临床医生不应该盲目地遵循所有的指南建议；伴随的证据水平告知哪些建议是基于可靠的证据。证据水平较低的主题，或那些建议不一致或缺失的主题，可能会激励进一步的临床研究。
