9
Table 23. Antiplatelet Agents and Aspirin
Recommendations
COR LOE
e use of aspirin for cardiovascular (including but not specific to stroke)
prophylaxis is reasonable for people whose risk is sufficiently high (10-
year risk >10%) for the benefits to outweigh the risks associated with
treatment. A cardiovascular risk calculator to assist in estimating 10-year
risk can be found online at http://my.americanheart.org/cvriskcalculator.
IIa A
Aspirin (81 mg daily or 100 mg every other day) can be useful for the
prevention of a first stroke among women, including those with diabetes
mellitus, whose risk is sufficiently high for the benefit to outweigh the
risks associated with treatment.
IIa B
Aspirin might be considered for the prevention of a first stroke in
people with chronic kidney disease (ie, estimated glomerular filtration
rate <45 mL/min/1.73 m
2
).
is recommendation does not apply to severe kidney disease
(stage 4 or 5; estimated glomerular filtration rate <30 mL/min/1.73 m
2
).
IIb C
Cilostazol may be reasonable for the prevention of a first stroke in people
with peripheral arterial disease.
IIb B
Aspirin is NOT useful for preventing a first stroke in low-risk individuals. III A
Aspirin is NOT useful for preventing a first stroke in people with diabetes
mellitus in the absence of other high-risk conditions.
III A
Aspirin is NOT useful for preventing a first stroke in people with
diabetes mellitus and asymptomatic peripheral artery disease (defined as
asymptomatic in the presence of an ankle brachial index ≤0.99).
III B
e use of aspirin for other specific situations (eg, AF, carotid artery
stenosis) is discussed in the relevant sections of this statement.
As a result of a lack of relevant clinical trials, antiplatelet regimens other
than aspirin and cilostazol are NOT recommended for the prevention of
a first stroke.
III C
Table 24. Primary Prevention in the ED
Recommendations
COR LOE
ED-based smoking cessation programs and interventions are recommended. I B
Identification of AF and evaluation for anticoagulation in the ED are
recommended.
I B
ED population screening for hypertension is reasonable. IIa C
When a patient is identified as having a drug or alcohol abuse problem,
ED referral to an appropriate therapeutic program is reasonable.
IIa C
e effectiveness of screening, brief intervention, and referral for treatment
of diabetes mellitus and lifestyle stroke risk factors (obesity, alcohol/
substance abuse, sedentary lifestyle) in the ED setting is not established.
IIb C
Table 25. Preventive Health Services
Recommendation
COR LOE
It is reasonable to implement programs to systematically identify and
treat risk factors in all patients at risk for stroke.
IIa A
