Prevention of perioperative stroke in patients undergoing non-cardiac surgery.

About 300 million adults undergo non-cardiac surgery annually. Although, in this setting, the incidence of perioperative stroke is low, the absolute number of patients experiencing a stroke is substantial. Furthermore, most patients with this complication will die or end up with severe disability. Covert brain infarctions are more frequent than overt strokes and are associated with postoperative delirium, cognitive decline, and cerebrovascular events at 1 year after surgery. Evidence shows that traditional stroke risk factors including older age, hypertension, and atrial fibrillation are also associated with perioperative stroke; previous stroke is the strongest risk factor for perioperative stroke. Increasing evidence also suggests the pathogenic role of perioperative events, such as hypotension, new atrial fibrillation, paradoxical embolism, and bleeding. Clinicians involved in perioperative care should be aware of this evidence on prevention strategies to improve patient outcomes after non-cardiac surgery.

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Declaration of interests MM has been co-investigator in investigator-initiated research projects supported by grants or in-kind contributions from Cloud DX and Roche Diagnostics. ARA's research group has received grants and funding from The Medicines Company and Masimo and has performed sponsor-initiated work for The Medicines Company and Rigel. ARA has received honoraria and grants from Paion, The Medicines Company, Terumo, BD (Carefusion), Philips, Ever Pharma, and Johnson & Johnson (Janssen Pharmaceutica). PJD is a member of a research group with a policy of not accepting honorariums or other payments from industry for their own personal financial gain. PJD's research group do accept honorariums or payments from industry to support research endeavours and costs to participate in meetings. Based on study questions PJD originated and grants he has written, he has received grants from Abbott Diagnostics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Cloud DX, Coviden, Octapharma, Philips Healthcare, Roche Diagnostics, Siemens, and Stryker. PJD has also participated in an advisory board meeting for GlaxoSmithKline, Bayer, Quidel Canada, and Trimedic and an expert panel meeting with AstraZeneca, Boehringer Ingelheim, and Roche. MTVC and EES declare no competing interests.