Anti-inflammatory therapy for preventing stroke and other vascular events after ischaemic stroke or transient ischaemic attack.
Angina, Unstable
/ prevention & control
Anti-Inflammatory Agents
/ therapeutic use
Heart Arrest
/ prevention & control
Humans
Ischemic Attack, Transient
/ complications
Myocardial Infarction
/ prevention & control
Plaque, Atherosclerotic
/ complications
Secondary Prevention
/ methods
Stroke
/ etiology
Journal
The Cochrane database of systematic reviews
ISSN: 1469-493X
Titre abrégé: Cochrane Database Syst Rev
Pays: England
ID NLM: 100909747
Informations de publication
Date de publication:
11 May 2020
11 May 2020
Historique:
entrez:
12
5
2020
pubmed:
12
5
2020
medline:
12
9
2020
Statut:
epublish
Résumé
An increasing body of evidence suggests that inflammation plays a key role in stroke, in particular stroke of atherosclerotic origin. Anti-inflammatory medications are a widely heterogeneous group of drugs that are used to suppress the innate inflammatory pathway and thus prevent persistent or recurrent inflammation. Anti-inflammatory agents have the potential to stabilise atherosclerotic plaques by impeding the inflammatory pathway. By targeting specific cytokines, the inflammatory pathway may be interrupted at various stages. To assess the benefits and harms of anti-inflammatory medications plus standard care versus standard care with or without placebo for prevention of vascular events (stroke, myocardial infarction (MI), non-fatal cardiac arrest, unstable angina requiring revascularisation, vascular death) and all-cause mortality in people with a prior history of ischaemic stroke or transient ischaemic attack (TIA). We searched the Cochrane Central Register of Controlled Trials (CENTRAL; last searched 29 May 2019); MEDLINE (1948 to 29 May 2019); Embase (1980 to 29 May 2019); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 29 May 2019); and Scopus (1995 to 29 May 2019). In an effort to identify additional published, unpublished, and ongoing trials, we searched several grey literature sources (last searched 30 May 2019). We incorporated all identified studies into the results section. We applied no restrictions with respect to language, date of publication, or study setting. We considered randomised controlled trials (RCTs) and cluster-randomised controlled trials that evaluated anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA. Two review authors independently assessed for inclusion titles and abstracts of studies identified by the search. Two review authors independently reviewed full-text articles for inclusion in this review. We planned to assess risk of bias and to apply the GRADE method. We identified no studies that met the inclusion criteria. There is currently a paucity of evidence on the use of anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA. RCTs are needed to assess whether use of anti-inflammatory medications in this setting is beneficial.
Sections du résumé
BACKGROUND
BACKGROUND
An increasing body of evidence suggests that inflammation plays a key role in stroke, in particular stroke of atherosclerotic origin. Anti-inflammatory medications are a widely heterogeneous group of drugs that are used to suppress the innate inflammatory pathway and thus prevent persistent or recurrent inflammation. Anti-inflammatory agents have the potential to stabilise atherosclerotic plaques by impeding the inflammatory pathway. By targeting specific cytokines, the inflammatory pathway may be interrupted at various stages.
OBJECTIVES
OBJECTIVE
To assess the benefits and harms of anti-inflammatory medications plus standard care versus standard care with or without placebo for prevention of vascular events (stroke, myocardial infarction (MI), non-fatal cardiac arrest, unstable angina requiring revascularisation, vascular death) and all-cause mortality in people with a prior history of ischaemic stroke or transient ischaemic attack (TIA).
SEARCH METHODS
METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; last searched 29 May 2019); MEDLINE (1948 to 29 May 2019); Embase (1980 to 29 May 2019); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 29 May 2019); and Scopus (1995 to 29 May 2019). In an effort to identify additional published, unpublished, and ongoing trials, we searched several grey literature sources (last searched 30 May 2019). We incorporated all identified studies into the results section. We applied no restrictions with respect to language, date of publication, or study setting.
SELECTION CRITERIA
METHODS
We considered randomised controlled trials (RCTs) and cluster-randomised controlled trials that evaluated anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA.
DATA COLLECTION AND ANALYSIS
METHODS
Two review authors independently assessed for inclusion titles and abstracts of studies identified by the search. Two review authors independently reviewed full-text articles for inclusion in this review. We planned to assess risk of bias and to apply the GRADE method.
MAIN RESULTS
RESULTS
We identified no studies that met the inclusion criteria.
AUTHORS' CONCLUSIONS
CONCLUSIONS
There is currently a paucity of evidence on the use of anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA. RCTs are needed to assess whether use of anti-inflammatory medications in this setting is beneficial.
Identifiants
pubmed: 32392374
doi: 10.1002/14651858.CD012825.pub2
pmc: PMC7261652
doi:
Substances chimiques
Anti-Inflammatory Agents
0
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
CD012825Subventions
Organisme : Chief Scientist Office
ID : ETM/417
Pays : United Kingdom
Informations de copyright
Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Références
Ann Neurol. 2012 May;71(5):709-18
pubmed: 22461139
Cochrane Database Syst Rev. 2020 May 11;5:CD012825
pubmed: 32392374
Stroke. 2009 Jun;40(6):2276-93
pubmed: 19423857
Stroke. 2005 Dec;36(12):2748-55
pubmed: 16254218
Circulation. 2006 May 16;113(19):2320-8
pubmed: 16651471
Curr Pharm Des. 2018;24(6):668-674
pubmed: 29336246
Stroke. 2016 Apr;47(4):1045-52
pubmed: 26979864
Ther Adv Neurol Disord. 2018 Jul 30;11:1756286418789854
pubmed: 30083232
N Engl J Med. 2017 Sep 21;377(12):1119-1131
pubmed: 28845751
Ann Rheum Dis. 2015 Mar;74(3):480-9
pubmed: 25561362
Eur Heart J. 2018 Oct 7;39(38):3518-3520
pubmed: 29955817
N Engl J Med. 2016 Jul 7;375(1):35-43
pubmed: 27160892
Lancet. 2012 Mar 31;379(9822):1205-13
pubmed: 22421339
Stroke. 2007 Apr;38(4):1189-96
pubmed: 17332449
N Engl J Med. 2013 Jul 4;369(1):11-9
pubmed: 23803136
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
Circulation. 2003 Nov 11;108(19):2317-22
pubmed: 14568895
Neurology. 2004 Feb 24;62(4):569-73
pubmed: 14981172
Stroke. 2018 May;49(5):1210-1216
pubmed: 29567761
Stroke. 2014 Dec;45(12):3561-6
pubmed: 25370581
J Am Coll Cardiol. 2013 Apr 23;61(16):1679-85
pubmed: 23500260
J Thromb Thrombolysis. 2012 Jan;33(1):88-94
pubmed: 21918905
Stroke. 2001 Nov;32(11):2575-9
pubmed: 11692019
Lancet. 2010 Jan 9;375(9709):132-40
pubmed: 20031199
Stroke. 2010 May;41(5):844-50
pubmed: 20299667
Nature. 2002 Dec 19-26;420(6917):868-74
pubmed: 12490960
J Nucl Med. 2009 Oct;50(10):1611-20
pubmed: 19759117
BMJ. 2004 Jun 19;328(7454):1490
pubmed: 15205295
N Engl J Med. 2016 Apr 21;374(16):1533-42
pubmed: 27096581
N Engl J Med. 2019 Feb 21;380(8):752-762
pubmed: 30415610
Lancet. 2013 Aug 10;382(9891):507-15
pubmed: 23726159
Lancet. 2012 Mar 31;379(9822):1214-24
pubmed: 22421340
Stroke. 2013 Jul;44(7):2064-89
pubmed: 23652265
Stroke. 2013 Mar;44(3):734-9
pubmed: 23362077
Stroke. 2000 Mar;31(3):774-81
pubmed: 10700518
Circulation. 2017 Mar 7;135(10):e146-e603
pubmed: 28122885
Curr Drug Deliv. 2017;14(4):449-457
pubmed: 28155595
PLoS One. 2018 Sep 19;13(9):e0203362
pubmed: 30231067
J Am Coll Cardiol. 2013 Jan 29;61(4):404-410
pubmed: 23265346