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Guidelines for the preventive treatment of ischaemic stroke and TIA (II). Recommendations according to aetiological sub-type
Guía para el tratamiento preventivo del ictus isquémico y AIT (II). Recomendaciones según subtipo etiológico
B. Fuentes
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hplapazneuro@meditex.es

Corresponding author.
, J. Gállego, A. Gil-Nuñez, A. Morales, F. Purroy, J. Roquer, T. Segura, J. Tejada, A. Lago, E. Díez-Tejedor, representing the ad hoc committee of the SEN Study Group for Cerevrovascular Diseases ◊, M. Alonso de Leci¿nana, J. Álvarez-Sabin, J. Arenillas, S. Calleja, I. Casado, M. Castellanos, J. Castillo, A. Dávalos, F. Díaz-Otero..., J.A. Egido, J.C. López-Fernández, M. Freijo, A. García Pastor, F. Gilo, P. Irimia, J. Maestre, J. Masjuan, J. Martí-Fábregas, P. Martínez-Sánchez, E. Martínez-Vila, C. Molina, F. Nombela, M. Ribó, M. Rodríguez-Yañez, F. Rubio, J. Serena, P. Simal, J. VivancosVer más
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            "apellidos" => "Egido"
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            "apellidos" => "L&#243;pez-Fern&#225;ndez"
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            "apellidos" => "Freijo"
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            "apellidos" => "Maestre"
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            "apellidos" => "Mart&#237;nez-S&#225;nchez"
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            "apellidos" => "Rib&#243;"
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    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Gu&#237;a para el tratamiento preventivo del ictus isqu&#233;mico y AIT &#40;II&#41;&#46; Recomendaciones seg&#250;n subtipo etiol&#243;gico"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In Spain&#44; cerebrovascular diseases &#40;CVD&#41; are the leading cause of death in women&#44; the third most frequent in men&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the most common cause of disability&#46; The measures we describe here are designed to prevent both first-ever ischaemic strokes &#40;IS&#41; and future episodes in patients who have already suffered a stroke&#46; We will also consider measures aimed at reducing overall vascular risk in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Due to the length of this article&#44; we decided to publish it in 2 parts&#46; The first part presented a review of the risk factors for ischaemic stroke<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and any modifications that would need to be made to prevent IS&#46; In this second part&#44; we will specify different preventive treatments according to the stroke subtype&#46; Recommendations for each section are shown in tables for better readability&#46; Levels of evidence and recommendation grades are based on the classification proposed by the Centre for Evidence Based Medicine at the University of Oxford<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; To facilitate reading&#44; we have included transient ischaemic attack &#40;TIA&#41; in our definition of ischaemic stroke&#46; This practice coincides with current criteria&#46; Therefore&#44; all recommendations included in these clinical practice guidelines are directed at preventing focal cerebral ischaemia in general&#44; without distinguishing between cerebral infarct and TIA&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Ischaemic stroke associated with large-vessel arteriosclerosis and small-vessel disease &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Risk factors &#40;RF&#41; should be modified&#46; In addition&#44; antiplatelet drugs are recommended along with carotid endarterectomy or percutaneous transluminal angioplasty in selected patients&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Antiplatelet drugs</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Acetylsalicylic acid &#40;ASA&#41;</span><p id="par0015" class="elsevierStylePara elsevierViewall">ASA reduces the absolute risk of stroke&#44; acute myocardial infarction &#40;AMI&#41;&#44; or vascular death by 13&#37; to 25&#37; compared to placebo&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> This is a first-choice antiplatelet drug and the recommended dose is 100 to 300<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Clopidogrel</span><p id="par0020" class="elsevierStylePara elsevierViewall">In patients with atherosclerotic disease &#40;AMI&#44; stroke&#44; or peripheral artery disease&#41;&#44; ASA is slightly more effective for reducing the risk of stroke&#44; AMI&#44; and vascular death &#40;decrease in relative risk of 8&#46;7&#37;&#41; with fewer digestive tract haemorrhages and the same risk of neutropenia&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> A sub-analysis in the CAPRIE study found that clopidogrel was no more effective than ASA in patients with a prior stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However&#44; clopidogrel was more effective in the subgroup of patients with a history of symptomatic atherosclerosis &#40;prior IS or AMI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> These observations should be considered with care&#44; given that the CAPRIE study was not designed for subgroup analysis&#46; Clopidogrel dosed at 75<span class="elsevierStyleHsp" style=""></span>mg&#47;day is considered a first-choice treatment&#44; especially in patients with ASA intolerance&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Triflusal</span><p id="par0025" class="elsevierStylePara elsevierViewall">In doses of 600<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; triflusal has a similar efficacy to that of ASA with fewer haemorrhagic complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a> It is also considered a first-choice treatment&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Dipyridamole</span><p id="par0030" class="elsevierStylePara elsevierViewall">Although dipyridamole reduces stroke recurrence by 18&#37; compared to placebo&#44; it is not used in monotherapy because it has no effect on vascular death&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Cilostazol</span><p id="par0035" class="elsevierStylePara elsevierViewall">The Second Cilostazol Stroke Prevention Study &#40;CSPS2&#41;&#44; conducted in Asian patients with IS&#44; showed that cilostazol &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41; was noninferior and could even be superior to ASA &#40;81<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41; for preventing stroke recurrences due to being associated with a lower frequency of haemorrhagic complications&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> A recent Cochrane meta-analysis confirms that cilostazol was superior to ASA for preventing stroke recurrence in patients with IS&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Other antiplatelet drugs under study</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Sarpogrelate</span><p id="par0040" class="elsevierStylePara elsevierViewall">Sarpogrelate&#39;s efficacy for secondary stroke prevention resembles that of ASA&#44; and its haemorrhagic complication rate is lower&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">SCH 530348</span><p id="par0045" class="elsevierStylePara elsevierViewall">Follow-up on stroke patients was interrupted prematurely in the TRA-TIMI50 study as there was an increased risk of haemorrhage&#46; The drug is still being investigated for patients with ischaemic heart disease or peripheral artery disease&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Prasugrel</span><p id="par0050" class="elsevierStylePara elsevierViewall">Compared to clopidogrel&#44; prasugrel significantly reduced cardiovascular episodes in patients at moderate to high risk for acute coronary syndrome and treated with percutaneous coronary angioplasty&#46; It is associated with a higher number of haemorrhagic complications&#59; mortality was similar in both groups&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> This drug is not recommended in patients in early phases after stroke or TIA&#44; and there have been no trials investigating its potential for secondary stroke prevention&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ticagrelor</span><p id="par0055" class="elsevierStylePara elsevierViewall">Compared to clopidogrel&#44; ticagrelor reduced the number of AMI and vascular deaths or deaths due to other causes among patients with acute coronary syndrome&#46; While there were no differences in the overall number of major haemorrhagic complications&#44; the percentage of fatal cerebral haemorrhages was lower&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> No studies have been conducted to specifically examine secondary stroke prevention with ticagrelor&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Associations of antiplatelet drugs</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">ASA and dipyridamole</span><p id="par0060" class="elsevierStylePara elsevierViewall">The ESPS2 and ESPRIT studies were the first to identify the combination of ASA and dipyridamole &#40;ASA&#47;DPR&#41; as being superior to ASA for preventing vascular episodes&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> However&#44; the validity of these results has been called into question due to methodology problems&#46; A systematic review showed that the ASA&#47;DPR combination&#44; compared to ASA alone&#44; decreased the risk of a new&#44; non-fatal stroke by 23&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The PRoFESS study compared clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg&#47;d to ASA 25<span class="elsevierStyleHsp" style=""></span>mg&#47;DPR 200<span class="elsevierStyleHsp" style=""></span>mg &#40;extended release&#44; administered twice daily&#41;&#46; That study found that ASA&#47;DPR was not superior to clopidogrel in the areas of secondary stroke prevention&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> functional recovery&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> or the potential development of cognitive impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">ASA and clopidogrel</span><p id="par0065" class="elsevierStylePara elsevierViewall">The MATCH study examined the efficacy of the combination of ASA 75<span class="elsevierStyleHsp" style=""></span>mg&#47;d and clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg&#47;d &#40;ASA&#47;CLP&#41;&#44; compared to clopidogrel alone&#44; in patients with a history of stroke or TIA&#46; The combination was not superior to clopidogrel and it was associated with a significantly higher risk of haemorrhage&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Additionally&#44; the CHARISMA<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> study in patients with clinically evident vascular disease or multiple RFs did not show ASA&#47;CLP to have greater efficacy for stroke recurrence reduction than ASA monotherapy&#46; One of the objectives of the study Secondary Prevention of Small Subcortical Strokes &#40;SPS3&#41;&#44; currently underway&#44; is to evaluate the efficacy of ASA&#47;CLP in reducing stroke recurrence in patients with small vessel disease&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Other combinations</span><p id="par0070" class="elsevierStylePara elsevierViewall">Additional combinations of anti-platelet drugs have also been tested&#44; including ASA&#47;DPR&#47;CLP and ASA&#47;CLP with glycoprotein IIb&#47;IIIa inhibitors&#46; Data were insufficient in both cases to yield recommendations for stroke prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Oral anticoagulant agents</span><p id="par0075" class="elsevierStylePara elsevierViewall">The SPIRIT study<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> compared high-intensity oral anticoagulants &#40;3&#46;0-4&#46;5 INR&#41; to ASA &#40;30<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41;&#46; It was terminated prematurely due to a high volume of haemorrhagic complications in the anticoagulant group&#46; The WARSS<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> study compared 325<span class="elsevierStyleHsp" style=""></span>mg&#47;d ASA to warfarin adjusted for an INR target of 1&#46;4 to 2&#46;8 and had identified no differences at the 2-year point&#46; The ESPRIT study concluded that medium-intensity oral anticoagulants &#40;2-3 INR&#41; were no more effective than ASA for secondary prevention of IS&#44; and that any possible protective effect was cancelled out by the number of haemorrhagic complications&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> One systematic review showed that anticoagulants &#40;INR of up to 2&#46;6&#41; displayed no advantages compared to antiplatelet treatment with regard to either risk of death by vascular causes or overall mortality&#46; Furthermore&#44; intensive anticoagulant treatment &#40;3-4&#46;5 INR&#41; is associated with a significant increase in total mortality and severe haemorrhagic episodes&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Data from studies or specific cases of non-cardioembolic stroke appear below&#46;</p><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Stenosis of the intracranial arteries</span><p id="par0085" class="elsevierStylePara elsevierViewall">The WASID study for symptomatic intracranial stenosis was interrupted prematurely since warfarin showed higher rates of haemorrhagic complications and no benefits compared to ASA dosed at 1300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Basilar artery stenosis</span><p id="par0090" class="elsevierStylePara elsevierViewall">An analysis of the WASID study suggested that these patients might benefit from anticoagulant treatment even though differences were not significant&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Stroke recurrence despite antiplatelet treatment</span><p id="par0095" class="elsevierStylePara elsevierViewall">Oral anticoagulants have not shown any benefits in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p></span></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Vascular interventional procedures</span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Extracranial carotid artery stenosis</span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Carotid endarterectomy</span><p id="par0100" class="elsevierStylePara elsevierViewall">Endarterectomy offers more advantages than medical treatment in cases of symptomatic carotid stenosis &#62;<span class="elsevierStyleHsp" style=""></span>70&#37;&#46; The NASCET study shows an improvement of 17&#37; at the 2-year mark<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> and ECST shows 14&#37; improvement at the 3-year mark&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> For moderate cases of stenosis &#40;50-69&#37;&#41;&#44; the benefit of carotid endarterectomy is less pronounced &#40;4&#46;5&#37; reduction in absolute risk at 5 years&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#59; there is no significant benefit for stenosis &#60;<span class="elsevierStyleHsp" style=""></span>50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;39</span></a> In contrast&#44; a meta-analysis that includes the ECST and NASCET studies points to higher benefits from endarterectomy in men&#44; patients older than 75 years&#44; and patients undergoing the procedure within 2 weeks of the stroke or TIA&#59; it is less effective at later dates&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> It is currently indicated in patients with symptomatic carotid stenosis of 70&#37; to 99&#37; and an additional life expectancy of more than 5 years&#44; provided that the hospital in question has a surgical morbidity and mortality rate of less than 6&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41&#8211;43</span></a> Endarterectomy may be considered in patients with symptomatic carotid stenosis of 50&#37; to 69&#37;&#44; but certain variables may affect the risk-benefit balance&#58; female sex &#40;no clear benefit in clinical trials&#41;&#59; initial manifestation as hemispheric IS &#40;better results than in retinal ischaemia&#41;&#59; or presence of a contralateral carotid occlusion&#44; which is associated with a greater preoperative risk although benefits remain&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;43</span></a> Medical treatment without endarterectomy is indicted in patients with carotid stenosis &#60;<span class="elsevierStyleHsp" style=""></span>50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41&#8211;43</span></a></p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Percutaneous transluminal angioplasty</span><p id="par0105" class="elsevierStylePara elsevierViewall">This technique has shown good results in patients with fibromuscular dysplasia&#44; lesions due to radiotherapy&#44; or restenosis following endarterectomy&#46; It has been suggested as a treatment alternative for stenosing atherosclerosis&#46; The CAVATAS study showed similar efficacy and safety results for percutaneous transluminal angioplasty and endarterectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> Technical advances include specific angioplasty balloons&#44; stents&#44; and most recently&#44; distal protection devices&#46; The SAPPHIRE study of carotid angioplasty and stenting showed that the technique was superior to endarterectomy in patients with a high level of surgical risk and symptomatic or asymptomatic carotid stenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> However&#44; early interruption of the EVA-3S study due to high rates of 30-day mortality or stroke in the carotid angioplasty group&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> and the SPACE study&#39;s failure to demonstrate that the technique was noninferior to carotid endarterectomy may constitute reasons to question carotid angioplasty as a safe alternative&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> However&#44; long-term follow-up &#40;2&#8211;4 years&#41; has shown similar levels of reduction of ipsilateral IS for both techniques&#44; although researchers stress the need to improve short-term safety results of carotid angioplasty and stenting&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48&#44;49</span></a> A meta-analysis indicates that endovascular treatment is associated with a modest increase in stroke and death rates 30 days after the procedure&#44; with no significant intergroup differences in rates of incapacitating stroke or death at 30 days&#46; On the other hand&#44; surgical treatment is associated with a significant increase in cranial nerve palsy and AMI&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> The ICSS study<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> found a 3&#46;3&#37; difference in absolute risk of stroke&#44; death&#44; or AMI at 120 days that pointed to endarterectomy as the superior technique&#46; The CAVATAS study<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> identified a higher incidence of non-perioperative stroke in patients with endovascular treatment &#40;21&#46;1&#37;&#41; than in those treated with endarterectomy &#40;15&#46;4&#37;&#41;&#46; This difference was observed even after the 2-year randomisation process&#44; and it may be explained by the higher incidence of restenosis following angioplasty&#46; Only a small group of patients in the CAVATAS study underwent stenting &#40;22&#37;&#41;&#46; The true long-term incidence rate for post-stent restenosis is unknown&#46; The CREST study&#44; conducted in patients with high-grade stenosis&#44; whether symptomatic &#40;53&#37;&#41; or asymptomatic &#40;47&#37;&#41;&#44; observed no significant differences regarding the study&#39;s main objective&#46; During the periprocedural period&#44; however&#44; there was a greater risk of non-disabling stroke with stenting&#44; and a greater risk of AMI with endarterectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> One important consideration is that over time &#40;4 years&#41;&#44; the rates of stroke recurrence were very low with both treatment options&#46; This may be partially explained by the high percentage of asymptomatic patients in this group&#46; Factors associated with a higher risk of periprocedural stroke or death with carotid angioplasty include male sex&#44; age &#62;<span class="elsevierStyleHsp" style=""></span>70 years&#44; prior stroke&#44; and having experienced a stroke rather than a TIA&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48&#44;54</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In cases of symptomatic stenosis of the common carotid artery&#44; the reasonable options are revascularisation by carotid angioplasty&#44; direct arterial reconstruction&#44; or extra-anatomic bypass grafting&#46; However&#44; available evidence is insufficient to make recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a></p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Extracranial vertebral artery stenosis&#59; subclavian artery stenosis</span><p id="par0115" class="elsevierStylePara elsevierViewall">Indications for revascularisation in cases of proximal vertebral artery stenosis are infrequent&#59; generally speaking&#44; the contralateral artery will supply the basilar artery sufficiently&#46; In cases of stroke recurrence despite appropriate medical treatment&#44; surgical or endovascular treatment may be considered&#46; Evidence is insufficient to recommend one procedure over another&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;55</span></a> Surgical options include trans-subclavian vertebral endarterectomy&#44; transposition of the vertebral artery to the ipsilateral common carotid artery&#44; and reimplantation of the vertebral artery using a venous graft extension to the subclavian artery&#46; The only randomised study on endovascular treatment in patients with vertebral artery stenosis was CAVATAS&#44; which randomised 16 patients to receive either endovascular treatment and medical treatment&#44; or medical treatment alone&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> In cases of cerebral ischaemia in the posterior cerebral territory due to subclavian artery stenosis&#44; doctors may consider the possibility of a carotid-subclavian extra-anatomic bypass for cases with low surgical risk&#46; Percutaneous angioplasty and stenting should be considered in cases with an elevated risk of surgical complications&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a></p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Intracranial arterial stenosis</span><p id="par0120" class="elsevierStylePara elsevierViewall">The WASID trial found a yearly risk of stroke of 11&#37; despite the best medical treatment&#59; this figure was 19&#37; in the subgroup with stenosis &#8805;<span class="elsevierStyleHsp" style=""></span>70&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> These patients present a high risk of recurrent ischaemia in the territory of the stenosed artery&#46; This is also seen in the vertebrobasilar territory &#40;12&#37; at 1 year and 15&#37; at 2 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a> In 2005&#44; the FDA approved the use of the Wingspan stent system&#44; which is effective in 96&#46;7 to 98&#46;8&#37; of all cases and has a 30-day complication rate of 6&#46;1 to 9&#46;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a> In one European registry&#44; 25 to 30&#37; of patients experienced restenosis &#40;mostly asymptomatic&#41;&#44; while 4&#46;8&#37; experienced an incapacitating stroke&#46; The mortality rate was 2&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> Researchers recently halted the SAMMPRIS study &#40;Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis&#41;&#46; The study compared angioplasty and the Wingspan stent system associated with medical treatment &#40;modification of risk factors and ASA&#47;CLP combination treatment&#41; to medical treatment alone in patients with symptomatic intracranial stenosis &#62;<span class="elsevierStyleHsp" style=""></span>70&#37; and IS in the first 30 days&#46; Recruitment was stopped after 451 patients&#44; rather than the anticipated 764 since significant benefits were found for the medical treatment group&#44; which yielded lower rates of stroke or death at 30 days &#40;5&#46;8&#37; in the medical treatment group vs 14&#37; in the Wingspan group&#41;&#46;</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Extra-intracranial arterial anastomosis</span><p id="par0125" class="elsevierStylePara elsevierViewall">Approximately 10&#37; of patients with non-disabling stroke present occlusion or stenosis of the internal carotid artery or middle cerebral artery&#46; Effects of this condition might be reduced by anastomosing the superficial temporal branch of the external carotid artery to an extra-intracranial bypass&#44; although the only completed clinical trial yielded negative results&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> Regardless of the effectiveness this technique has displayed in selected patients with giant aneurysm of the internal carotid artery&#44; or moyamoya disease in young patients&#44; there are currently no indications for extra-intracranial anastomosis as a means of preventing stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a> Results from the clinical trial Carotid Occlusion Surgery Study&#44; presented at ISC 2011&#44; did not show surgery to be an effective means of preventing stroke recurrence at 2 years because of the low recurrence rate in the non-surgical group&#46;</p></span></span></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Ischaemic stroke of cardioembolic origin &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;</span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Nonvalvular atrial fibrillation</span><p id="par0130" class="elsevierStylePara elsevierViewall">Current treatment follows 2 strategies&#58; prevention of thromboembolism using antithrombotic agents&#44; and treatment of the FA itself&#44; including stabilising both heart rate and rhythm&#46; Furthermore&#44; new non-pharmacological treatments are being developed to decrease risk of stroke in patients with non-valvular AF&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">62&#8211;64</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Oral anticoagulant agents</span><p id="par0135" class="elsevierStylePara elsevierViewall">The European Atrial Fibrillation Trial &#40;EAFT&#41; in stroke patients with non-valvular AF showed a 66&#37; decrease in the IS recurrence rate in the warfarin group&#44; vs a 15&#37; decrease in the ASA group &#40;300<span class="elsevierStyleHsp" style=""></span>mg&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> The number needed to treat &#40;NNT&#41; to avoid one stroke per year is 14 for warfarin and 50 for ASA&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> While vitamin K antagonists &#40;VKA&#41; are effective&#44; they pose significant problems in clinical practice and are consequentially often underused&#46; Vitamin K antagonists may also be dosed incorrectly due to their delayed action and metabolism&#44; narrow therapeutic range&#44; the considerable variation in their metabolism process and numerous interactions with foods and other drugs&#44; the presence of genetic polymorphisms that affect the dosing requirements&#44; and the need for regular coagulation monitoring and frequent dose adjustments&#44; which generates additional costs&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a> As a result&#44; only 10&#37; to 18&#37; of these patients have an appropriate INR&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">67&#44;68</span></a> Risk of haemorrhage is another severe problem with VKA treatment&#46; This risk can be reduced by treating AHT and monitoring INR&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a> If the range is appropriate &#40;2-3 INR&#41;&#44; the risk of cerebral haemorrhage is 0&#46;5&#37; per year with a NNT of 200&#59; this is acceptable when compared to the NNT of 14 for avoiding a stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> We recommend using the HAS-BLED scale of risk of severe haemorrhage to assess the risk-benefit balance of oral anticoagulants&#46; Patients with scores &#8805;<span class="elsevierStyleHsp" style=""></span>3 are considered to be at high risk&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a> On the other hand&#44; despite risk of haemorrhage&#44; oral anticoagulants show clear benefits in patients over 85 and with AF&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">New anticoagulants are currently available &#40;thrombin and factor X inhibitors&#41; that provide the added advantage of not requiring INR level monitoring&#46; Dabigatran dosed at 100<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h has shown similar efficacy to warfarin treatment for stroke reduction&#46; It is associated with a lower frequency of major haemorrhages&#59; at doses of 150<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; it is more effective than warfarin for stroke reduction with similar haemorrhage rates&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">71</span></a> Dabigatran is easy to administer&#44; as it has set doses and does not require monitoring&#46; Analysis of the subgroup with IS showed efficacy results for dabigatran that were similar to those for the total group&#44; but tending towards superiority over warfarin&#46; Both dabigatran dosages also showed a significantly lower risk of intracranial haemorrhage and haemorrhagic stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">72</span></a> In a cost-effectiveness study in patients older than 65 years with a CHADS2 score &#8805;<span class="elsevierStyleHsp" style=""></span>2&#44; dabigatran proved itself to be an alternative to warfarin based on prices in the USA&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">73</span></a> Dabigatran has been approved by the FDA and by Health Canada&#44; and it is pending approval in Europe&#46; European and AHA guidelines<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">63&#44;74</span></a> place dabigatran on par with VKAs for stroke prevention in patients with AF&#46; Doses of 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h are indicated in patients with a lower risk of cardioembolism or a higher risk of haemorrhage &#40;very advanced age&#44; poorly managed AHT&#44; prior cerebral haemorrhage&#44; neuroimaging evidence of leukoaraiosis or cerebral microhaemorrhage&#44; or HAS-BLED score &#8805;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; Doses of 150<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h are indicated for patients with a higher risk of cardioembolism or INR below the therapeutic range despite VKA treatment&#44; or where there are other VKA-related problems&#46; For secondary prevention of cardioembolic stroke&#44; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h is an appropriate dose in patients with a HAS-BLED score &#60; 3 or stroke recurrence despite correct treatment with VKAs&#46; The dose of 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h is recommended for HAS-BLED scores &#8805;<span class="elsevierStyleHsp" style=""></span>3&#46; The AVERROES study<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">75</span></a> in patients with AF and a VKA contraindication showed a significant impact by apixaban compared to ASA on the annual stroke or systemic embolism rate &#40;1&#46;6&#37; vs 3&#46;6&#37;&#41;&#46; Haemorrhage rates were similar for both treatments&#46; The ROCKET AF study<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">76&#44;77</span></a> demonstrated that rivaroxaban dosed at 20<span class="elsevierStyleHsp" style=""></span>mg every 24<span class="elsevierStyleHsp" style=""></span>hours is noninferior to warfarin as a means of preventing stroke and peripheral embolism without increasing risk of haemorrhage&#46; Analysis of the treated population found significant differences &#40;1&#46;71&#37; vs 2&#46;16&#37;&#41; with rivaroxaban appearing to be superior&#46; Other anticoagulants currently being developed include edoxaban and betrixaban&#46;</p></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Antiplatelet drugs</span><p id="par0145" class="elsevierStylePara elsevierViewall">The EAFT study<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> showed that oral anticoagulants were clearly superior to ASA 300<span class="elsevierStyleHsp" style=""></span>mg for secondary stroke prevention&#46; The ACTIVE-A study showed that 2 antiplatelet drugs used in combination &#40;ASA 75-100<span class="elsevierStyleHsp" style=""></span>mg&#47;CLP 75<span class="elsevierStyleHsp" style=""></span>mg&#41; in patients with a contraindication for VKAs achieved a 28&#37; reduction in risk of stroke compared to ASA alone &#40;75-100<span class="elsevierStyleHsp" style=""></span>mg&#41;&#46; However&#44; there was a significant increase in risk of major haemorrhagic complications&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">78</span></a> In contrast&#44; the ACTIVE W study found oral anticoagulants to be superior to the ASA 75-100<span class="elsevierStyleHsp" style=""></span>mg&#47;CLP 75<span class="elsevierStyleHsp" style=""></span>mg combination for reducing stroke&#44; systemic embolism&#44; AMI&#44; and vascular death&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a></p></span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Combining oral anticoagulants and antiplatelet drugs</span><p id="par0150" class="elsevierStylePara elsevierViewall">In cases of embolism recurrence despite appropriate anticoagulant treatment&#44; empirical treatment calls for associating these drugs with ASA&#46; Nevertheless&#44; studies have found no differences in stroke or systemic embolism reduction through treatment with warfarin and ASA compared to warfarin alone&#44; whereas the combination is associated with a significant increase in haemorrhagic complications&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">80</span></a> On the other hand&#44; a significant reduction in the risk of death of vascular causes&#44; TIA&#44; non-fatal stroke&#44; and systemic embolism has been observed with the combination of triflusal 600<span class="elsevierStyleHsp" style=""></span>mg&#47;day and moderate-intensity anticoagulants&#44; without a significant increase in haemorrhagic complications&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a> A long-term analysis of one patient subgroup found that the combination of triflusal 600<span class="elsevierStyleHsp" style=""></span>mg&#47;day and an oral anticoagulant was superior to anticoagulant only&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">82</span></a></p></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Antiarrhythmic agents</span><p id="par0155" class="elsevierStylePara elsevierViewall">A post hoc analysis of the ATHENA<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">83</span></a> study in patients with persistent or paroxysmal AF found that dronedarone reduced risk of stroke by 36&#37; regardless of presence or absence of antithrombotic treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a> Doctors should maintain anticoagulant treatment after stabilising cardiac rhythm in patients with an elevated risk of cardioembolism &#40;CHADS2<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> After cardiac ablation&#44; the AF recurrence rate is 13&#37; at 2 years&#44; 21&#46;8&#37; at 3 years&#44; 35&#37; at 4 years&#44; 46&#46;8&#37; at 5 years&#44; and 54&#46;6&#37; at 6 years&#46; Even patients who do not experience recurrence in the first year cannot be considered cured&#59; follow-up studies show that 40&#37; will experience recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a></p></span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Other drug treatments</span><p id="par0160" class="elsevierStylePara elsevierViewall">Use of statins may prevent either appearance or recurrence of AF&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a> Use of ACE inhibitors or ARBs to block the renin-angiotensin system has been shown to reduce the risk of de novo AF&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">88</span></a></p></span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">Non-pharmacological treatments</span><p id="par0165" class="elsevierStylePara elsevierViewall">In most patients with non-valvular AF&#44; thrombi are located in the left atrial appendage&#46; As a result&#44; one possible approach would be excising that structure in selected patients with absolute contraindications to oral anticoagulants&#46; In the PROTECT AF study&#44; percutaneous closure of the atrial appendage was noninferior to warfarin for stroke prevention&#44; although it yielded a higher rate of periprocedural complications&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">89</span></a></p></span></span><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Other causes of cardioembolism</span><p id="par0170" class="elsevierStylePara elsevierViewall">Evidence regarding risk and recommendations for preventing stroke due to other cardioembolic causes are not as clear as in non-valvular AF or in other specific situations&#46;</p></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0245">Acute myocardial infarction &#40;AMI&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Early onset of heparin treatment followed by oral anticoagulants decreased the risk of IS from 3&#37; to 1&#37; and yielded a &#62;<span class="elsevierStyleHsp" style=""></span>50&#37; reduction in thrombus formation&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> A minimum of 3 months of oral anticoagulant treatment is recommended in anterior AMI with a thrombus detected by an imaging study&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">90</span></a> A meta-analysis comparing oral anticoagulants associated with ASA or used in monotherapy&#44; ASA alone&#44; or placebo found that while warfarin did not reduce mortality or re-infarction rates&#44; it did decrease risk of stroke while also increasing risk of major haemorrhage&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">91</span></a></p></span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0250">Cardiomyopathy with heart failure</span><p id="par0180" class="elsevierStylePara elsevierViewall">In the Warfarin and Antiplatelet Therapy in Chronic Heart Failure trial &#40;WATCH&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">92</span></a> warfarin was associated with a significantly lower stroke rate &#40;0&#46;6&#37;&#41; than ASA dosed at 162<span class="elsevierStyleHsp" style=""></span>mg&#47;day or clopidogrel at 75<span class="elsevierStyleHsp" style=""></span>mg&#47;day &#40;2&#46;3&#37;&#41;&#46; However&#44; the study&#39;s statistical power is insufficient to establish which treatment is better&#46; Another study&#44; Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction &#40;WARCEF&#41;&#44; is currently underway in patients with LVEF &#8804; 35&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">93</span></a></p></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0255">Rheumatic mitral stenosis</span><p id="par0185" class="elsevierStylePara elsevierViewall">Oral anticoagulant treatment is recommended in patients with mitral stenosis and AF or prior embolism&#44; even when they maintain sinus rhythm&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">94</span></a></p></span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0260">Mitral valve prolapse</span><p id="par0190" class="elsevierStylePara elsevierViewall">There are no available clinical trials in patients with stroke and mitral valve prolapse&#46; Stroke patients with mitral valve prolapse will require an aetiological study to rule out other possible causes of stroke&#46; If no other causes are identified&#44; antiplatelet treatment is recommended according to general indications for preventing recurrences of stroke of undetermined origin&#46; Oral anticoagulants should be prescribed when patients experience recurrence despite ASA treatment&#44; evidence of prior systemic embolism&#44; or associated AF&#46;</p></span><span id="sec0205" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0265">Valve replacements</span><p id="par0195" class="elsevierStylePara elsevierViewall">The indication for antithrombotic treatment depends on the type of replacement and associated RFs&#46; As a means of reducing thromboembolic complications&#44; warfarin has been shown to be superior to 2 different antiplatelet regimens &#40;ASA dosed at 650 or 990<span class="elsevierStyleHsp" style=""></span>mg&#47;day &#43; dipyridamole 150-225<span class="elsevierStyleHsp" style=""></span>mg&#47;day or ASA 650<span class="elsevierStyleHsp" style=""></span>mg&#47;day &#43; pentoxifylline 800<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">95</span></a> Oral anticoagulants are indicated for mechanical valves&#59; however&#44; even when INR levels are appropriate &#40;2&#46;5&#8211;3&#46;5&#41;&#44; there is still a yearly risk of thromboembolism of 1-2&#37;&#46; Valves in the mitral position are at more risk than those in the aortic position&#46; INR should therefore remain between 2&#46;5 and 3&#46;5 for mechanical valves in the mitral position&#44; but lower&#44; between 2&#46;0 and 3&#46;0&#44; for bivalvular or Medtronic Hall valves in the aortic position&#44; provided that the factors mentioned above are not present&#46; For biological valves&#44; oral anticoagulants are recommended during the first 3 months after surgery&#44; which is when emboli are most likely to appear &#40;before the valve is completely endothelialised&#41;&#46; Subsequently&#44; doctors may consider long-term antiplatelet therapy with low-dose ASA &#40;75-100<span class="elsevierStyleHsp" style=""></span>mg&#41;&#44; provided that the patient does not have associated RFs such as AF&#44; history of thromboembolism&#44; left ventricular dysfunction&#44; or a hypercoagulable state&#46; Oral anticoagulants are recommended in these cases&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">94</span></a> Associating low doses of ASA &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; or dipyridamole with an oral anticoagulant is more effective for reducing risk of embolism in patients with mechanical valve replacements and stroke recurrence despite appropriate anticoagulant treatment&#46; However&#44; this does significantly increase risk of haemorrhage&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">96</span></a></p></span><span id="sec0210" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0270">Patent foramen ovale &#40;PFO&#41; and atrial septal aneurysm &#40;ASA&#41;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Preventive treatment is not indicated for asymptomatic patients with patent foramen ovale&#59; risk of stroke in a patient with PFO resembles that in the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">90&#44;97</span></a> If doctors suspect paradoxical embolism due to deep vein thrombosis in a stroke patient with PFO&#44; anticoagulant treatment should be administered for at least 3 months&#46; In other cases&#44; treatment will depend on the risk of recurrence&#44; which is estimated based on co-presence of PFO and other anomalies that are associated with an increased yearly risk of recurrence&#46; Such anomalies include hypercoagulable state or co-presence of an ASA&#59; the significance of the latter is more debatable&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">98&#8211;100</span></a> PICSS&#44; a sub-study of the WARSS clinical trial&#44; observed no differences in recurrence rates among patients with cryptogenic stroke and PFO treated with either aspirin or oral anticoagulants&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">101</span></a> For lack of results from clinical trials on stroke prevention in patients with PFO&#44; antiplatelet treatment is considered appropriate for stroke patients with isolated PFO&#46; Oral anticoagulants are suitable for patients with high-risk PFO or stroke recurrence despite treatment&#46; Results from the CLOSURE-I study<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">102</span></a> show that percutaneous closure of PFO is nonsuperior to medical treatment for stroke prevention&#44; and that its complication rate is higher&#46; The RESPECT and REDUCE trials are still underway&#44; and at present&#44; percutaneous closure of PFO is not recommended except in clinical trials&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">103</span></a></p></span></span><span id="sec0215" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0275">Infarcts of rare causes &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;</span><p id="par0205" class="elsevierStylePara elsevierViewall">In this section&#44; we consider only the main aetiologies implicated in IS of rare causes in our setting&#46; These include artery dissection&#44; prothrombotic states&#44; atheromatous plaque in the aortic arch&#44; and lastly&#44; thrombosis of dural sinuses&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><span id="sec0220" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0280">Artery dissection</span><p id="par0210" class="elsevierStylePara elsevierViewall">There is no evidence regarding treatment of carotid or extracranial vertebral dissection&#59; analysis of studies performed with either ASA or oral anticoagulants does not reveal significant differences between these regimens&#46;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">104&#8211;106</span></a> A prospective study showed a higher frequency of major haemorrhages with antithrombotic treatment &#40;antiplatelet&#44; 1&#37;&#59; anticoagulant&#44; 2&#37;&#41; than of IS &#40;0&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">104</span></a> As efficacy is similar&#44; it would be reasonable to use the drug with the lowest haemorrhagic risk&#44; that is&#44; the antiplatelet drug&#46; Doctors believe that maintaining treatment during 3 to 6 months is appropriate&#44; although no studies support this&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> A systematic review of cases of carotid or vertebral artery dissection treated with angioplasty and stenting concluded that this technique is safe&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">107</span></a> However&#44; no conclusions can be drawn regarding its efficacy&#44; since there are no studies comparing this option to medical treatment&#46;</p></span><span id="sec0225" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0285">Prothrombotic states</span><p id="par0215" class="elsevierStylePara elsevierViewall">Deep vein thrombosis is an indication for short- or long-term anticoagulation therapy&#44; depending on the clinical and haematological circumstances&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">108</span></a> Although there are guidelines establishing general recommendations for acquired hypercoagulable states&#44; there is no specific evidence regarding secondary stroke prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> Oral anticoagulants are recommended in cases of protein C&#44; S&#44; and antithrombin III deficiency&#44; especially in high-risk situations and for secondary prevention&#46; For secondary prevention in patients with lupus anticoagulant&#44; anticoagulant treatment is indicated&#44; although there are no appropriately designed studies that assess the efficacy of that treatment compared to antiplatelet treatment&#46; The APASS study revealed that the presence of antiphospholipid antibodies was not associated with an increased risk of stroke recurrence or with a different response to treatment with ASA 325<span class="elsevierStyleHsp" style=""></span>mg&#47;day or warfarin with an INR of 1&#46;4-2&#46;8&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">109</span></a> Based on these data&#44; aspirin and low-intensity anticoagulation may be considered preventive treatments in patients with antiphospholipid antibody positivity after a first ischaemic stroke&#46; Oral anticoagulants for an INR of 2-3 are recommended for cases of antiphospholipid syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p></span><span id="sec0230" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0290">Atheromatous plaque in the aortic arch</span><p id="par0220" class="elsevierStylePara elsevierViewall">Atheromatous plaque in the aortic arch is associated with an elevated risk of stroke recurrence and death&#44; especially if plaques measure &#8805;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm or they are complex &#40;presence of ulceration or mobile components&#41; despite treatment with ASA or oral anticoagulants&#46;<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">110&#44;111</span></a> In a retrospective study&#44; use of statins was independently associated with less stroke recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">112</span></a> The Aortic Arch Related Cerebral Hazard Trial &#40;ARCH&#41;&#44; currently underway&#44; compares warfarin to ASA&#47;CLP combination therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">113</span></a> Oral anticoagulants or ASA treatment may be considered to prevent recurrent stroke in patients with ASA and atheromatous plaque in the aortic arch measuring 4<span class="elsevierStyleHsp" style=""></span>mm or larger&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">114</span></a></p></span><span id="sec0235" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0295">Cerebral&#47;dural venous sinus thrombosis</span><p id="par0225" class="elsevierStylePara elsevierViewall">Treatment with oral anticoagulants should be maintained for at least 3 months to avoid rethrombosis following the early-phase anticoagulant treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0575"><span class="elsevierStyleSup">115&#44;116</span></a> The decision to extend the treatment over the long term will depend on whether or not a prothrombotic risk factor is detected&#46; If this risk factor is transient&#44; anticoagulants may be discontinued after 3 months&#46; For lower-risk situations&#44; such as protein C or S deficiency&#44; or heterozygosity for factor V Leiden or for the prothrombin G20210A mutation&#44; anticoagulants may be maintained during 6 months&#46; In contrast&#44; for high-risk situations such as antithrombin deficiency&#44; homozygosity for factor V Leiden&#44; or co-presence of 2 or more prothrombotic conditions&#44; long-term anticoagulation is recommended&#46; This is also true in cases of multiple episodes of idiopathic venous thrombosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">117&#44;118</span></a></p></span></span><span id="sec0240" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0300">Ischaemic stroke of undetermined origin</span><p id="par0230" class="elsevierStylePara elsevierViewall">In <span class="elsevierStyleItalic">cryptogenic IS</span>&#44; antiplatelet drugs are recommended as the primary treatment method&#46; Some authors recommend anticoagulants when strokes recur despite treatment with antiplatelet drugs&#46; In cases of <span class="elsevierStyleItalic">IS of undetermined aetiology</span> due to an incomplete work-up&#44; missing data must be obtained so as to start the most suitable treatment&#46; For <span class="elsevierStyleItalic">IS of several possible aetiologies</span>&#44; treatment should be tailored to the cause with the highest risk of recurrence and act on all causes where possible&#46;</p></span><span id="sec0245" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0305">Conflicts of interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "sec0005"
          "titulo" => "Ischaemic stroke associated with large-vessel arteriosclerosis and small-vessel disease &#40;Table 2&#41;"
          "secciones" => array:5 [
            0 => array:3 [
              "identificador" => "sec0010"
              "titulo" => "Antiplatelet drugs"
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                0 => array:2 [
                  "identificador" => "sec0015"
                  "titulo" => "Acetylsalicylic acid &#40;ASA&#41;"
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                  "titulo" => "SCH 530348"
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              "titulo" => "Associations of antiplatelet drugs"
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                  "titulo" => "ASA and dipyridamole"
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                  "titulo" => "ASA and clopidogrel"
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              "titulo" => "Other combinations"
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              "titulo" => "Oral anticoagulant agents"
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                  "titulo" => "Stenosis of the intracranial arteries"
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                  "titulo" => "Basilar artery stenosis"
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                  "identificador" => "sec0100"
                  "titulo" => "Stroke recurrence despite antiplatelet treatment"
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          "titulo" => "Vascular interventional procedures"
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              "titulo" => "Extracranial carotid artery stenosis"
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                  "titulo" => "Carotid endarterectomy"
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                  "titulo" => "Percutaneous transluminal angioplasty"
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                2 => array:2 [
                  "identificador" => "sec0125"
                  "titulo" => "Extracranial vertebral artery stenosis&#59; subclavian artery stenosis"
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                3 => array:2 [
                  "identificador" => "sec0130"
                  "titulo" => "Intracranial arterial stenosis"
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                4 => array:2 [
                  "identificador" => "sec0135"
                  "titulo" => "Extra-intracranial arterial anastomosis"
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          "identificador" => "sec0140"
          "titulo" => "Ischaemic stroke of cardioembolic origin &#40;Table 3&#41;"
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              "identificador" => "sec0145"
              "titulo" => "Nonvalvular atrial fibrillation"
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                  "identificador" => "sec0150"
                  "titulo" => "Oral anticoagulant agents"
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                  "titulo" => "Antiplatelet drugs"
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                  "identificador" => "sec0160"
                  "titulo" => "Combining oral anticoagulants and antiplatelet drugs"
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                  "identificador" => "sec0165"
                  "titulo" => "Antiarrhythmic agents"
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                  "identificador" => "sec0170"
                  "titulo" => "Other drug treatments"
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                  "titulo" => "Non-pharmacological treatments"
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              "identificador" => "sec0180"
              "titulo" => "Other causes of cardioembolism"
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            2 => array:2 [
              "identificador" => "sec0185"
              "titulo" => "Acute myocardial infarction &#40;AMI&#41;"
            ]
            3 => array:2 [
              "identificador" => "sec0190"
              "titulo" => "Cardiomyopathy with heart failure"
            ]
            4 => array:2 [
              "identificador" => "sec0195"
              "titulo" => "Rheumatic mitral stenosis"
            ]
            5 => array:2 [
              "identificador" => "sec0200"
              "titulo" => "Mitral valve prolapse"
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            6 => array:2 [
              "identificador" => "sec0205"
              "titulo" => "Valve replacements"
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              "identificador" => "sec0210"
              "titulo" => "Patent foramen ovale &#40;PFO&#41; and atrial septal aneurysm &#40;ASA&#41;"
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          "identificador" => "sec0215"
          "titulo" => "Infarcts of rare causes &#40;Table 4&#41;"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0220"
              "titulo" => "Artery dissection"
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            1 => array:2 [
              "identificador" => "sec0225"
              "titulo" => "Prothrombotic states"
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            2 => array:2 [
              "identificador" => "sec0230"
              "titulo" => "Atheromatous plaque in the aortic arch"
            ]
            3 => array:2 [
              "identificador" => "sec0235"
              "titulo" => "Cerebral&#47;dural venous sinus thrombosis"
            ]
          ]
        ]
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          "identificador" => "sec0240"
          "titulo" => "Ischaemic stroke of undetermined origin"
        ]
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          "identificador" => "sec0245"
          "titulo" => "Conflicts of interest"
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          "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0325">Additional References</span>"
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          "titulo" => "References"
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    "fechaRecibido" => "2011-06-09"
    "fechaAceptado" => "2011-06-29"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec309379"
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            0 => "Guidelines"
            1 => "Ischaemic stroke"
            2 => "Transient ischemic attack"
            3 => "Prevention"
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            0 => "Gu&#237;a de pr&#225;ctica cl&#237;nica"
            1 => "Ictus isqu&#233;mico"
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            3 => "Prevenci&#243;n"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To update the <span class="elsevierStyleItalic">ad hoc</span> Committee of the Cerebrovascular Diseases Study Group of The Spanish Neurological Society guidelines on prevention of ischemic stroke &#40;IS&#41; and Transient Ischaemic Attack &#40;TIA&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We reviewed the available evidence on ischaemic stroke and TIA prevention according to aetiological subtype&#46; Levels of evidence and recommendation levels are based on the classi&#64257;cation of the Centre for Evidence-Based Medicine&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In atherothrombotic IS&#44; antiplatelet therapy and revascularization procedures in selected cases of ipsilateral carotid stenosis &#40;70&#8211;99&#37;&#41; reduce the risk of recurrences&#46; In cardioembolic IS &#40;atrial &#64257;brillation&#44; valvular diseases&#44; prosthetic valves and myocardial infarction with mural thrombus&#41; prevention is based on the use of oral anticoagulants&#46; Preventive therapies for uncommon causes of IS will depend on the aetiology&#46; In the case of cerebral venous thrombosis oral anticoagulation is effective&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We conclude with recommendations for clinical practice in prevention of IS according to the aetiological subtype presented by the patient&#46;</p>"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Actualizar las gu&#237;as terap&#233;uticas del Comit&#233; ad hoc del Grupo de Estudio de Enfermedades Cerebrovasculares de la SEN en el tratamiento preventivo de ictus isqu&#233;mico &#40;II&#41; y ataque isqu&#233;mico transitorio &#40;AIT&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n de evidencias disponibles sobre la prevenci&#243;n del ictus isqu&#233;mico y AIT en funci&#243;n del subtipo etiol&#243;gico&#46; Los niveles de evidencia y grados de recomendaci&#243;n se han basado en la clasi&#64257;caci&#243;n del Centro de Medicina Basada en la Evidencia&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el II de origen aterotromb&#243;tico reducen el riesgo de recurrencias el tratamiento antiagregante y los procedimientos revascularizadores en casos seleccionados de estenosis carotidea ipsilateral &#40;70-99&#37;&#41;&#46; La prevenci&#243;n de II de origen cardioemb&#243;lico &#40;&#64257;brilaci&#243;n auricular&#44; valulopat&#237;as&#44; pr&#243;tesis valvulares y en infarto de miocardio con trombo mural&#41; se basa en el uso de anticoagulantes orales&#46; En el II de origen inhabitual&#44; las terapias preventivas depender&#225;n dela etiolog&#237;a&#59; en la trombosis venosa cerebral la anticoagulaci&#243;n oral es e&#64257;caz&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se concluye con recomendaciones de pr&#225;ctica cl&#237;nica en prevenci&#243;n de ictus isqu&#233;mico y AIT adaptadas al subtipo etiol&#243;gico de II que ha presentado el paciente&#46;</p>"
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      0 => array:2 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Author affiliations and members of the committee are listed in the <a class="elsevierStyleCrossRef" href="#sec0255">Addendum</a>&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fuentes B&#44; G&#225;llego J&#44; Gil-Nu&#241;ez A&#44; Morales A&#44; Purroy F&#44; Roquer J&#44; et al&#46; Gu&#237;a para el tratamiento preventivo del ictus isqu&#233;mico y AIT &#40;II&#41;&#46; Recomendaciones seg&#250;n subtipo etiol&#243;gico&#46; Neurolog&#237;a&#46; 2014&#59;29&#58;168&#8211;183&#46;</p>"
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            "apendice" => "<p id="par0245" class="elsevierStylePara elsevierViewall">Ad hoc committee of the SEN Study Group for Cerebrovascular Diseases formed to draw up clinical practice guidelines for stroke&#46;</p> <p id="par0255" class="elsevierStylePara elsevierViewall">Coordinator&#58; Exuperio D&#237;ez-Tejedor&#44; Hospital Universitario La Paz&#44; Madrid&#46;</p>"
            "etiqueta" => "Addendum"
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                "apendice" => "<p id="par0260" class="elsevierStylePara elsevierViewall">Exuperio D&#237;ez-Tejedor &#40;Coord&#41;&#44; Hospital Universitario La Paz&#44; Madrid&#59; Blanca Fuentes &#40;Secretary&#41;&#44; Hospital Universitario La Paz&#44; Madrid&#59; Mar&#237;a Alonso de Leci&#241;ana&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#59; Jos&#233; &#193;lvarez-Sabin&#44; Hospital Universitari Vall d&#8217;Hebron&#44; Barcelona&#59; Juan Arenillas&#44; Hospital Universitario Cl&#237;nico de Valladolid&#59; Sergio Calleja&#44; Hospital Universitario Central de Asturias&#44; Oviedo&#59; Ignacio Casado&#44; Hospital San Pedro&#44; C&#225;ceres&#59; Mar Castellanos&#44; Hospital Josep Trueta&#44; Girona&#59; Jos&#233; Castillo&#44; Hospital Cl&#237;nico Universitario&#44; Santiago de Compostela&#59; Antonio D&#225;valos&#44; Hospital Universitari Germans Trias i Pujol&#44; Badalona&#59; Fernando D&#237;az-Otero&#44; Hospital Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#59; Exuperio D&#237;ez-Tejedor&#44; Hospital Universitario La Paz&#44; Madrid&#59; Jos&#233; Antonio Egido&#44; Hospital Cl&#237;nico Universitario San Carlos&#44; Madrid&#59; Juan Carlos Fern&#225;ndez&#44; Hospital Universitario Dr&#46; Negr&#237;n&#44; Las Palmas&#59; Mar Freijo&#44; Hospital Universitario de Basurto&#44; Bilbao&#59; Blanca Fuentes&#44; Hospital Universitario La Paz&#44; Madrid&#59; Jaime G&#225;llego&#44; Hospital General de Navarra&#44; Pamplona&#59; Andr&#233;s Garc&#237;a Pastor&#44; Hospital Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#59; Antonio Gil-N&#250;&#241;ez&#44; Hospital Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#59; Francisco Gilo&#44; Hospital Universitario La Princesa&#44; Madrid&#59; Pablo Irimia&#44; Cl&#237;nica Universitaria de Navarra&#44; Pamplona&#59; Aida Lago&#44; Hospital Universitario La Fe&#44; Valencia&#59; Jos&#233; Maestre&#44; Hospital Universitario Virgen de las Nieves&#44; Granada&#59; Jaime Masjuan&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#59; Joan Mart&#237;-F&#225;bregas&#44; Hospital de la Santa Creu i Sant Pau&#44; Barcelona&#59; Patricia Mart&#237;nez-S&#225;nchez&#44; Hospital Universitario La Paz&#44; Madrid&#59; Eduardo Mart&#237;nez-Vila&#44; Cl&#237;nica Universitaria de Navarra&#44; Pamplona&#59; Carlos Molina&#44; Hospital Universitari Vall d&#8217;Hebron&#44; Barcelona&#59; Ana Morales&#44; Hospital Universitario Virgen de la Arrixaca&#44; Murcia&#59; Florentino Nombela&#44; Hospital Universitario La Princesa&#44; Madrid&#59; Francisco Purroy&#44; Hospital Universitario Arnau de Vilanova&#44; L&#233;rida&#59; Marc Rib&#243;&#44; Hospital Universitari Vall d&#8217;Hebron&#44; Barcelona&#59; Manuel Rodr&#237;guez-Y&#225;&#241;ez&#44; Hospital Cl&#237;nico Universitario&#44; Santiago de Compostela&#59; Jaime Roquer&#44; Hospital del Mar&#44; Barcelona&#59; Francisco Rubio&#44; Hospital Universitario de Bellvitge&#44; Barcelona&#59; Tom&#225;s Segura&#44; Hospital Universitario de Albacete&#44; Albacete&#59; Joaqu&#237;n Serena&#44; Hospital Josep Trueta&#44; Gerona&#59; Patricia Simal&#44; Hospital Cl&#237;nico Universitario San Carlos&#44; Madrid&#59; Javier Tejada&#44; Hospital Universitario de Le&#243;n&#44; Le&#243;n&#59; Jos&#233; Vivancos&#44; Hospital Universitario La Princesa&#44; Madrid&#46;</p>"
                "etiqueta" => "A&#46;1"
                "titulo" => "Drafting committee"
                "identificador" => "sec0260"
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                "apendice" => "<p id="par0265" class="elsevierStylePara elsevierViewall">Jos&#233; &#193;lvarez-Sab&#237;n&#44; Hospital Universitari Vall d&#8217;Hebron&#44; Barcelona&#59; Jos&#233; Castillo&#44; Hospital Cl&#237;nico Universitario&#44; Santiago de Compostela&#59; Exuperio D&#237;ez-Tejedor&#44; Hospital Universitario La Paz&#44; Madrid&#59; Antonio Gil-N&#250;&#241;ez&#44; Hospital Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#59; Jos&#233; Larracoechea&#44; Hospital de Cruces&#44; Bilbao&#59; Eduardo Mart&#237;nez-Vila&#44; Cl&#237;nica Universitaria de Navarra&#44; Pamplona&#59; Jaime Masjuan&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#59; Jorge Mat&#237;as-Guiu&#44; Hospital Cl&#237;nico Universitario San Carlos&#44; Madrid&#59; Francisco Rubio&#44; Hospital de Bellvitge&#44; Barcelona&#46;</p>"
                "etiqueta" => "A&#46;2"
                "titulo" => "Review or institutional committee"
                "identificador" => "sec0265"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Adapted from the Centre for Evidence Based Medicine &#40;CEBM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Level of evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Type of study on which classification is based&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grades of recommendation</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systematic review of randomised clinical trials &#40;with homogeneity&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B &#40;extrapolation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D &#40;inconclusive studies&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Randomised clinical trial with narrow confidence interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B &#40;extrapolation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D &#40;inconclusive studies&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systematic review of cohort studies &#40;with homogeneity&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C &#40;extrapolation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D &#40;inconclusive studies&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Individual cohort study &#40;including low-quality randomised clinical trials&#44; e&#46;g&#46; those with a follow-up level below 80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C &#40;extrapolation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D &#40;inconclusive studies&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systematic reviews of case&#8211;control studies &#40;with homogeneity&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C &#40;extrapolation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D &#40;inconclusive studies&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Case-control studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C &#40;extrapolation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D &#40;inconclusive studies&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Series of cases or cohort studies or low quality case-control studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D &#40;inconclusive studies&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Experts&#8217; opinion without explicit critical appraisal or based on physiology or pathophysiology&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Levels of evidence and grades of recommendation&#46;</p>"
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      1 => array:7 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Recommendations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Level of evidence and recommendation grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Antiplatelet drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Treatment with antiplatelet drugs is recommended to prevent recurrence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1a&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- ASA &#40;dosed at 50-300<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; reduces the absolute risk of stroke&#44; AMI&#44; or vascular death compared to placebo&#46; It is considered a first-choice drug&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1a&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Clopidogrel &#40;75<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; is modestly more effective than ASA for reducing risk of stroke&#44; AMI&#44; and vascular death in patients with atherosclerotic disease&#46; It is considered a first-choice drug&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Triflusal 600<span class="elsevierStyleHsp" style=""></span>mg&#47;day shows similar efficacy to ASA with fewer haemorrhagic complications&#44; and it is considered a first-choice treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1a&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- The combination of ASA &#40;25<span class="elsevierStyleHsp" style=""></span>mg&#41; and dipyridamole &#40;200<span class="elsevierStyleHsp" style=""></span>mg&#44; delayed-release&#41; taken twice daily reduces risk of stroke in a similar way to clopidogrel&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- The combination of ASA and clopidogrel is not recommended for preventing stroke due to large-vessel atherosclerosis or small-vessel disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Oral anticoagulant agents</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Oral anticoagulants are not recommended for prevention of stroke caused by large vessel atherosclerosis&#44; small vessel disease&#44; or intracranial artery stenosis&#44; except in patients with antiplatelet drug intolerance or contraindications for antiplatelet therapy&#44; or where emboligenic heart disease is also present&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1a&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Carotid endarterectomy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Carotid endarterectomy is recommended with ipsilateral carotid stenosis of 70&#37; to 99&#37; and an episode of TIA&#44; amaurosis fugax&#44; or cerebral ischaemia with minor sequelae in the preceding 6 months&#46; Hospitals should have a surgical morbidity and mortality rate of less than 6&#37;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1a&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- The procedure may be recommended in patients with 50&#37; to 69&#37; stenosis and men with risk factors and recent hemispheric symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- This treatment is not appropriate for stenoses of less than 50&#37;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- In cases of TIA or minor stroke&#44; the procedure should be carried out within 2 weeks of the episode&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1a&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Percutaneous transluminal carotid angioplasty</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Percutaneous transluminal angioplasty may be indicated as an alternative to carotid endarterectomy in symptomatic cases of carotid stenosis exceeding 50&#37; &#40;arteriography measurement&#41; or &#8805; 70&#37; &#40;non-invasive measurement&#41;&#46; It is especially feasible in patients in whom endarterectomy would be a high-risk or technically difficult procedure&#44; those with restenosis following endarterectomy&#44; stenosis after radiotherapy&#44; or medical contraindications including severe coronary artery disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Extra-intracranial anastomosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Extra-intracranial anastomosis is not recommended&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Intracranial endovascular treatment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Medical treatment&#44; including antiplatelet drugs&#44; statins&#44; and modifying risk factors&#44; is recommended for patients with symptomatic intracranial stenosis&#46; Endovascular treatment is not recommended&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Recommendations&#46; prevention of ischaemic stroke associated with large-vessel arteriosclerosis and small-vessel disease&#46;</p>"
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        "etiqueta" => "Table 3"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Recommendations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Level of evidence and recommendation grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Non-valvular atrial fibrillation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Primary prevention</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Oral anticoagulants are recommended for patients with non-valvular AF and a high risk of stroke &#40;CHADS &#8805; 2 or CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc &#8805; 1&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1a&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Treatment with ASA or oral anticoagulants may be indicated in patients with AF and a low to moderate risk level &#40;CHADS 1 or CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc 1&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1a&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Treatment with ASA or no treatment is recommended for patients with AF and a low risk level &#40;CHADS 0 or CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc 0&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Vitamin K antagonists&#44; direct thrombin inhibitors &#40;dabigatran&#41; or factor X inhibitors &#40;rivaroxaban&#44; apixaban&#41; are recommended for patients with an indication for oral anticoagulants&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1a&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- The combination of ASA and clopidogrel may be used in patients with contraindications for oral anticoagulants&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- The combination of ASA and warfarin is not recommended&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Percutaneous left atrial appendage closure may be an alternative to using warfarin to prevent stroke in patients in whom oral anticoagulants are strictly contraindicated&#46; The procedure is associated with higher rates of complications&#44; and should therefore be limited to patients with low complication rates and hospitals with experience&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Secondary prevention</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Oral anticoagulants are recommended for patients with stroke and non-valvular AF &#40;see &#8216;primary prevention&#8217; section and main text&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Acute myocardial infarction &#40;AMI&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Anticoagulant treatment over 3 months&#44; beginning with heparin followed by oral anticoagulants&#44; is recommended for cases of anterior AMI and thrombus detected by imaging techniques&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Sustained treatment with oral anticoagulants after acute myocardial infarction reduces risk of stroke&#44; but increases risk of major haemorrhagic complications&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Cardiomyopathy with heart failure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- In patients with stroke and heart failure&#44; warfarin treatment is superior to ASA or clopidogrel for reducing risk of stroke&#44; although statistical power is limited&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Rheumatic mitral stenosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Oral anticoagulant treatment is recommended in patients with mitral stenosis who present AF or prior embolism even when they maintain sinus rhythm&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Mitral valve prolapse</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- An aetiological study to rule out other possible causes of stroke is crucial in stroke patients with mitral valve prolapse&#46; If no other causes are identified&#44; treatment with antiplatelet drugs is recommended&#44; following general indications for preventing recurrences of stroke of undetermined origin&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Valve replacements</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Oral anticoagulant treatment with warfarin &#40;2&#46;5-3&#46;5 INR&#41; is superior to antiplatelet drugs for reducing thromboembolic complications in patients with mechanical valve replacements&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- For patients with biological valve replacements&#44; oral anticoagulants are recommended during the first 3 months&#44; followed by low-dose ASA as an antiplatelet drug&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Associating ASA 100<span class="elsevierStyleHsp" style=""></span>g&#47;day with an oral anticoagulant delivers better reduction of the risk of embolism in patients with mechanical valve replacements and stroke recurrence despite appropriate anticoagulant treatment&#46; However&#44; this does significantly increase risk of haemorrhage&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Anomalies of the interatrial septum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Preventive treatment is not indicated for asymptomatic patients with patent foramen ovale&#59; risk of stroke in a patient with PFO resembles that in the general population &#40;primary prevention&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- If there is suspicion of paradoxical embolism due to deep vein thrombosis in a stroke patient with PFO&#44; anticoagulant treatment should be administered for at least 3 months&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- In other cases&#44; treatment will depend on risk of recurrence estimated based on the co-presence of PFO and other anomalies associated with elevated risk of recurrence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- For lack of results from clinical trials on stroke prevention in patients with PFO&#44; antiplatelet treatment is considered appropriate for stroke patients with isolated PFO&#46; Oral anticoagulants are suitable for patients with high-risk PFO or stroke recurrence despite treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Percutaneous closure of a PFO is no better than medical treatment as a means of preventing stroke&#44; and it is associated with more serious complications&#46; The procedure is not recommended&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 1b&#59; Recommendation grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Recommendations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Level of evidence and recommendation grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Artery dissection</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Treatment with ASA over 3 to 6 months is recommended due to being as effective as oral coagulants while causing fewer complications&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2a&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Atheromatous plaque in the aortic arch</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Oral anticoagulants &#40;2&#46;3 INR&#41; or treatment with ASA may be considered to prevent stroke recurrence in patients with cerebral ischaemia and aortic arch atheroma &#8805;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2b&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Use of statins in these patients may reduce risk of stroke recurrence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Cerebral&#47;dural venous sinus thrombosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Continuing treatment with oral coagulants is recommended during&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level of evidence 2a&#59; Recommendation grade B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-3 months if the prothrombotic imbalance is transient&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">-6 months for a low-risk case&#58; protein C or S deficiency&#44; heterozygosity for factor V Leiden or for the prothrombin G20210A mutation&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">- Indefinitely in a high-risk case&#58; antithrombin deficit&#44; homozygosity for factor V Leidenor the co-presence of 2 or more prothrombotic conditions&#44; and in cases of 2 or more episodes of idiopathic venous thrombosis&#46;&nbsp;\t\t\t\t\t\t\n
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                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica&#46; Defunciones seg&#250;n causa de muerte 2006&#46; &#91;accessed 29&#46;7&#46;11&#93;&#46; Available in&#58; <a id="intr0005" class="elsevierStyleInterRef" href="http://www.ine.es/prensa/np490.pdf">http&#58;&#47;&#47;www&#46;ine&#46;es&#47;prensa&#47;np490&#46;pdf</a>"
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                    0 => array:2 [
                      "titulo" => "Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke&#58; a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association&#47;American Stroke Association"
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                        0 => array:2 [ …2]
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                    0 => array:2 [
                      "doi" => "10.1161/01.STR.0000090125.28466.E2"
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                        "tituloSerie" => "Stroke"
                        "fecha" => "2003"
                        "volumen" => "34"
                        "paginaInicial" => "2310"
                        "paginaFinal" => "2322"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
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              ]
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              "identificador" => "bib0015"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gu&#237;a para el tratamiento preventivo del ictus isqu&#233;mico y AIT &#40;I&#41;&#46; Actuaci&#243;n sobre los factores de riesgo y estilo de vida"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nrl.2011.06.0023"
                      "Revista" => array:2 [
                        "tituloSerie" => "Neurolog&#237;a"
                        "fecha" => "2011"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0020"
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                0 => array:1 [
                  "referenciaCompleta" => "Centre for Evidence Based Medicine&#46; &#91;accessed 29&#46;7&#46;11&#93;&#46; Available in&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.cebm.net/">http&#58;&#47;&#47;www&#46;cebm&#46;net&#47;</a>"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Collaborative overview of randomised trials of antiplatelet therapy &#8211; I&#58; prevention of death&#44; myocardial infarction&#44; and stroke by prolonged antiplatelet therapy in various categories of patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                    0 => array:1 [
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                        "tituloSerie" => "BMJ"
                        "fecha" => "1994"
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                        "paginaInicial" => "81"
                        "paginaFinal" => "106"
                        "link" => array:1 [ …1]
                      ]
                    ]
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              "etiqueta" => "6"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cumulative meta-analysis of aspirin efficacy after cerebral ischaemia of arterial origin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Neurol Neurosurg Psychiatry"
                        "fecha" => "1999"
                        "volumen" => "66"
                        "paginaInicial" => "255"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death&#44; myocardial infarction&#44; and stroke in high risk patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                        "tituloSerie" => "BMJ"
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                        "volumen" => "324"
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                        "paginaFinal" => "86"
                        "link" => array:1 [ …1]
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              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspirin at any dose above 30<span class="elsevierStyleHsp" style=""></span>mg offers only modest protection after cerebral ischaemia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                        "tituloSerie" => "J Neurol Neuro-surg Psychiatry"
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                        "paginaInicial" => "197"
                        "paginaFinal" => "199"
                      ]
                    ]
                  ]
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              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A metaregression analysis of the dose&#8211;response effect of aspirin on stroke"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "1999"
                        "volumen" => "159"
                        "paginaInicial" => "1248"
                        "paginaFinal" => "1253"
                        "link" => array:1 [ …1]
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                    ]
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                ]
              ]
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              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
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                    0 => array:2 [
                      "titulo" => "A randomised&#44; blinded&#44; trial of clopidogrel versus aspirin in patients at risk of ischaemic events &#40;CAPRIE&#41;"
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                        0 => array:2 [ …2]
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                        "tituloSerie" => "Lancet"
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                        "paginaFinal" => "1339"
                        "link" => array:1 [ …1]
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              "identificador" => "bib0055"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events"
                      "autores" => array:1 [
                        0 => array:3 [ …3]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.STR.0000110221.54366.49"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2004"
                        "volumen" => "35"
                        "paginaInicial" => "528"
                        "paginaFinal" => "532"
                        "link" => array:1 [ …1]
                      ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of triflusal and aspirin for prevention of vascular events in patients after cerebral infarction&#58; the TACIP Study&#58; a randomized&#44; double-blind&#44; multicenter trial"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                    0 => array:2 [
                      "doi" => "10.1161/01.STR.0000063141.24491.50"
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                        "tituloSerie" => "Stroke"
                        "fecha" => "2003"
                        "volumen" => "34"
                        "paginaInicial" => "840"
                        "paginaFinal" => "848"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
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              ]
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              "identificador" => "bib0065"
              "etiqueta" => "13"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Triflusal vs aspirin for prevention of cerebral infarction&#58; a randomized stroke study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                        "tituloSerie" => "Neurology"
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                        "paginaInicial" => "1073"
                        "paginaFinal" => "1080"
                        "link" => array:1 [ …1]
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              "identificador" => "bib0070"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Triflusal for preventing serious vascular events in people at high risk"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
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                        "paginaInicial" => "CD004296"
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              "identificador" => "bib0075"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dipyridamole for preventing stroke and other vascular events in patients with vascular disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                  "host" => array:1 [
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              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cilostazol for prevention of secondary stroke &#40;CSPS 2&#41;&#58; an aspirin-controlled&#44; double-blind&#44; randomised non-inferiority trial"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                      "doi" => "10.1016/S1474-4422(10)70198-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Neurol"
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                        "paginaFinal" => "968"
                        "link" => array:1 [ …1]
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              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cilostazol versus aspirin for secondary prevention of vascular events after stroke of arterial origin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2011"
                        "paginaInicial" => "CD008076"
                      ]
                    ]
                  ]
                ]
              ]
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            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sarpogrelate-Aspirin Comparative Clinical Study for Efficacy and Safety in Secondary Prevention of Cerebral Infarction &#40;S-ACCESS&#41;&#58; a randomized&#44; double-blind&#44; aspirin-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA.107.505131"
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                        "tituloSerie" => "Stroke"
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                        "volumen" => "39"
                        "paginaInicial" => "1827"
                        "paginaFinal" => "1833"
                        "link" => array:1 [ …1]
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            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prasugrel versus clopidogrel in patients with acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0706482"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2007"
                        "volumen" => "357"
                        "paginaInicial" => "2001"
                        "paginaFinal" => "2015"
                        "link" => array:1 [ …1]
                      ]
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              "etiqueta" => "20"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ticagrelor versus clopidogrel in patients with acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0904327"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "361"
                        "paginaInicial" => "1045"
                        "paginaFinal" => "1057"
                        "link" => array:1 [ …1]
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              "etiqueta" => "21"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lowent-hal A&#44; European Stroke Prevention Study&#46; 2&#46; Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
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                        "tituloSerie" => "J Neurol Sci"
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                        "paginaInicial" => "1"
                        "paginaFinal" => "13"
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              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin &#40;ESPRIT&#41;&#58; randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:3 [ …3]
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                  "host" => array:1 [
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                      "doi" => "10.1016/S0140-6736(06)68734-5"
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                        "tituloSerie" => "Lancet"
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                        "volumen" => "367"
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                        "paginaFinal" => "1673"
                        "link" => array:1 [ …1]
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              ]
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              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspirin plus dipyridamole versus aspirin for prevention of vascular events after stroke or TIA&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                      "doi" => "10.1161/STROKEAHA.107.496281"
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                        "tituloSerie" => "Stroke"
                        "fecha" => "2008"
                        "volumen" => "39"
                        "paginaInicial" => "1358"
                        "paginaFinal" => "1363"
                        "link" => array:1 [ …1]
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              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0805002"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2008"
                        "volumen" => "359"
                        "paginaInicial" => "1238"
                        "paginaFinal" => "1251"
                        "link" => array:1 [ …1]
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                      "titulo" => "Effect of combined aspirin and extended-release dipyrida-mole versus clopidogrel on functional outcome and recurrence in acute&#44; mild ischemic stroke&#58; PRoFESS subgroup analysis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                        "paginaInicial" => "732"
                        "paginaFinal" => "738"
                        "link" => array:1 [ …1]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes &#40;PRoFESS&#41; trial&#58; a double-blind&#44; active and placebo-controlled study"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1474-4422(08)70198-4"
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                        "tituloSerie" => "Lancet Neurol"
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                        "volumen" => "7"
                        "paginaInicial" => "875"
                        "paginaFinal" => "884"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients &#40;MATCH&#41;&#58; randomised&#44; double-blind&#44; placebo-controlled trial"
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                        0 => array:2 [ …2]
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                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(04)16721-4"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2004"
                        "volumen" => "364"
                        "paginaInicial" => "331"
                        "paginaFinal" => "337"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
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              ]
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            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa060989"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2006"
                        "volumen" => "354"
                        "paginaInicial" => "1706"
                        "paginaFinal" => "1717"
                        "link" => array:1 [ …1]
                      ]
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                  ]
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              "identificador" => "bib0145"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Triple antiplatelet therapy for preventing vascular events&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1741-7015-8-36"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Med"
                        "fecha" => "2010"
                        "volumen" => "8"
                        "paginaInicial" => "36"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ana.410420606"
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                        "tituloSerie" => "Ann Neurol"
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                        "volumen" => "42"
                        "paginaInicial" => "857"
                        "paginaFinal" => "865"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0155"
              "etiqueta" => "31"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa011258"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2001"
                        "volumen" => "345"
                        "paginaInicial" => "1444"
                        "paginaFinal" => "1451"
                         …1
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0160"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medium intensity oral anticoagulants versus aspirin after cerebral ischaemia of arterial origin &#40;ESPRIT&#41;&#58; a randomised controlled trial"
                      "autores" => array:1 [ …1]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1474-4422(06)70685-8"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0165"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD001342.pub2"
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0170"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis"
                      "autores" => array:1 [ …1]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa043033"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
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              "identificador" => "bib0175"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Warfarin vs aspirin for symptomatic intracranial stenosis&#58; subgroup analyses from WASID"
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                    0 => array:2 [
                      "doi" => "10.1212/01.wnl.0000238506.76873.2f"
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              "identificador" => "bib0180"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis"
                      "autores" => array:1 [ …1]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199108153250701"
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                0 => array:2 [
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                      "autores" => array:1 [ …1]
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                    0 => array:1 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis&#46; North American Symptomatic Carotid Endarterectomy Trial Collaborators"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [ …6]
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                0 => array:2 [
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                    0 => array:1 [
                      "titulo" => "Endarterectomy for moderate symptomatic carotid stenosis&#58; interim results from the MRC European Carotid Surgery Trial"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(04)15785-1"
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for management of ischaemic stroke and transient ischaemic attack 2008"
                      "autores" => array:1 [ …1]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000131083"
                      "Revista" => array:6 [ …6]
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              "identificador" => "bib0210"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack&#58; a guideline for healthcare professionals from the American heart association&#47;American stroke association"
                      "autores" => array:1 [ …1]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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              "identificador" => "bib0215"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Carotid endarterectomy &#8211; an evidence-based review&#58; report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                ]
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              "identificador" => "bib0220"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study &#40;CAVATAS&#41;&#58; a randomised trial"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term results of carotid stenting versus endarterectomy in high-risk patients"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0708028"
                      "Revista" => array:6 [ …6]
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              "identificador" => "bib0230"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa061752"
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              "identificador" => "bib0235"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients&#58; a randomised non-inferiority trial"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis &#40;EVA-3S&#41; trial&#58; results up to 4 years from a randomised&#44; multicentre trial"
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                0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis&#58; meta-analysis of randomized trial data"
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                    0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
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              "identificador" => "bib0260"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study &#40;CAVATAS&#41;&#58; long-term follow-up of a randomised trial"
                      "autores" => array:1 [ …1]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Stenting versus endarterectomy for treatment of carotid-artery stenosis"
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                    0 => array:2 [
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                0 => array:2 [
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                0 => array:2 [
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                      "titulo" => "2011 ASA&#47;ACCF&#47;AHA&#47;AANN&#47;AANS&#47;ACR&#47;ASNR&#47;CNS&#47;SAIP&#47;SCAI&#47;SIR&#47;SNIS&#47;SVM&#47;SVS AT guideline on the management of patients with extracranial carotid and vertebral artery disease&#58; executive summary&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines&#44; and the American Stroke Association&#44; American Association of Neuroscience Nurses&#44; American Association of Neurological Surgeons&#44; American College of Radiology&#44; American Society of Neuroradiology&#44; Congress of Neurological Surgeons&#44; Society of Atherosclerosis Imaging and Prevention&#44; Society for Cardiovascular Angiography and Interventions&#44; Society of Interventional Radiology&#44; Society of NeuroInterventional Surgery&#44; Society for Vascular Medicine&#44; and Society for Vascular Surgery"
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                    0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study &#40;CAVATAS&#41;&#58; a randomized trial"
                      "autores" => array:1 [ …1]
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                0 => array:2 [
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                    0 => array:2 [
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                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.105.578229"
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                0 => array:2 [
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                    0 => array:2 [
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                    0 => array:2 [
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                    0 => array:2 [
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                    ]
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                      "titulo" => "Effect of medical treatment in stroke patients with patent foramen ovale&#58; patent foramen ovale in Cryptogenic Stroke Study"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                    0 => array:2 [
                      "titulo" => "Controlled Trial to Evaluate the Safety and Efficacy of the STARFlex Septal Closure System Versus Best Medical Therapy in Patients with Stroke or Transient Ischemic attack due to Presumed Paradoxical Embolism through a Patent Foramen Ovale"
                      "autores" => array:1 [ …1]
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                    0 => array:2 [
                      "titulo" => "Percutaneous device closure of patent foramen ovale for secondary stroke prevention&#58; a call for completion of randomized clinical trials&#58; a science advisory from the American Heart Association&#47;American Stroke Association and the American College of Cardiology Foundation"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.109.192272"
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              ]
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              "identificador" => "bib0520"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Aspirin vs anticoagulation in carotid artery dissection&#58; a study of 298 patients"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/WNL.0b013e3181a2a50a"
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                ]
              ]
            ]
            104 => array:3 [
              "identificador" => "bib0525"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Antithrombotic drugs for carotid artery dissection"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.STR.0000112970.63735.FC"
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                    ]
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                ]
              ]
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            105 => array:3 [
              "identificador" => "bib0530"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Treatment of cervical artery dissection&#58; a systematic review and meta-analysis"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/jnnp.2007.138800"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            106 => array:3 [
              "identificador" => "bib0535"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Endovascular stenting of extracranial carotid and vertebral artery dissections&#58; a systematic review of the literature"
                      "autores" => array:1 [ …1]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1227/NEU.0b013e318209ce03"
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                ]
              ]
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              "identificador" => "bib0540"
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                      "titulo" => "Long-term&#44; low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism"
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                    0 => array:2 [
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              ]
            ]
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              "identificador" => "bib0545"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke"
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                    0 => array:2 [
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                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.105.593418"
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            111 => array:3 [
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                    0 => array:1 [
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                    0 => array:1 [
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                  "host" => array:1 [
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-1331.2010.03011.x"
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            "texto" => "<p id="par0270" class="elsevierStylePara elsevierViewall">Granger CB&#44; Alexander JH&#44; McMurray JJ&#44; Lopes RD&#44; Hylek EM&#44; Hanna M&#44; Al-Khalidi HR&#44; Ansell J&#44; Atar D&#44; Avezum A&#44; Bahit MC&#44; Diaz R&#44; Easton JD&#44; Ezekowitz JA&#44; Flaker G&#44; Garcia D&#44; Geraldes M&#44; Gersh BJ&#44; Golitsyn S&#44; Goto S&#44; Hermosillo AG&#44; Hohnloser SH&#44; Horowitz J&#44; Mohan P&#44; Jansky P&#44; Lewis BS&#44; Lopez-Sendon JL&#44; Pais P&#44; ParkhomenkoA&#44; Verheugt FW&#44; Zhu J&#44; Wallentin L&#59; ARISTOTLE Committees and Investigators&#46;Apixaban versus warfarin in patients with atrial fibrillation&#46; N Engl J Med&#46; 2011 Sep 15&#59;365&#40;11&#41;&#58;981-92&#46;</p> <p id="par0275" class="elsevierStylePara elsevierViewall">Chimowitz MI&#44; Lynn MJ&#44; Derdeyn CP&#44; Turan TN&#44; Fiorella D&#44; Lane BF&#44; Janis LS&#44; Lutsep HL&#44; Barnwell SL&#44; Waters MF&#44; Hoh BL&#44; Hourihane JM&#44; Levy EI&#44; Alexandrov AV&#44; Harrigan MR&#44; Chiu D&#44; Klucznik RP&#44; Clark JM&#44; McDougall CG&#44; Johnson MD&#44; Pride GLJr&#44; Torbey MT&#44; Zaidat OO&#44; Rumboldt Z&#44; Cloft HJ&#59; SAMMPRIS Trial Investigators&#46; Stenting versus aggressive medical therapy for intracranial arterial stenosis&#46; N Engl J Med&#46; 2011 Sep 15&#59;365&#40;11&#41;&#58;993-1003&#46;</p>"
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Article information
ISSN: 21735808
Original language: English
DOI:10.1016/j.nrleng.2011.06.006
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