What are suitable topics for a narrative literature review on ischemic (cerebrovascular accident) stroke?

From the Guidelines

A suitable topic for a narrative literature review on ischemic stroke would be the management of specific risk factors for secondary prevention, including lifestyle modification, antithrombotic agents, and the use of antiplatelet agents for noncardioembolic stroke, as identified in recent global stroke guidelines 1. This topic is relevant as it directly impacts the management of patients with ischemic stroke, reducing the risk of recurrent stroke and other vascular outcomes. Some key areas to explore in this review include:

• The etiological diagnosis of ischemic stroke and TIA, and how it informs secondary prevention strategies
• The role of lifestyle modification, such as diet and exercise, in reducing the risk of recurrent stroke
• The use of antithrombotic agents, including antiplatelet agents and anticoagulants, in different cardioembolic sources and embolic stroke of undetermined source (ESUS)
• The management of specific risk factors, such as hypertension, diabetes, and hyperlipidemia, and how they contribute to the risk of recurrent stroke. The review could also examine the differences between guidelines in their comprehensiveness and the strength and level of evidence assigned to specific recommendations, as well as the knowledge gaps that exist in certain areas, such as the prevention of recurrent spontaneous intracerebral hemorrhage (ICH) 1. Overall, a narrative literature review on this topic would provide a comprehensive overview of the current state of knowledge on secondary prevention of ischemic stroke, and would be clinically relevant as it directly impacts patient care and outcomes.

From the Research

Suitable Topics for a Narrative Literature Review on Ischemic Stroke

Some potential topics for a narrative literature review on ischemic stroke include:

• The efficacy and safety of anticoagulation therapy in preventing recurrent stroke in patients with atrial fibrillation 2, 3, 4
• The role of antiplatelet and anticoagulant therapies in secondary stroke prevention, including the use of dual antiplatelet therapy and direct oral anticoagulants 3, 4
• The management of acute ischemic stroke in patients on anticoagulation, including the timing of anticoagulation resumption after stroke 2, 5
• The impact of different anticoagulants on the severity and prognosis of atrial fibrillation-related acute ischemic stroke 6
• The use of left atrial appendage occlusion plus anticoagulation versus continued anticoagulation alone in patients with atrial fibrillation and ischemic stroke 2
• The role of cytochrome P450 2C19 polymorphisms in guiding antiplatelet and anticoagulant therapy in patients with ischemic stroke 3
• The optimal duration of dual antiplatelet therapy in patients with symptomatic intracranial atherosclerosis 3

Key Considerations

When conducting a narrative literature review on ischemic stroke, it is essential to consider the following:

• The heterogeneity of patients with ischemic stroke, including those with atrial fibrillation and those without 2, 3
• The complexity of stroke mechanisms, including cardioembolic and non-cardioembolic mechanisms 2, 3
• The need for individualized approaches to secondary prevention, taking into account patient-specific factors such as bleeding risk and stroke mechanism 2, 3, 4
• The importance of balancing the risks of hemorrhagic transformation with the risk of recurrent stroke when making decisions about anticoagulation resumption after stroke 5