What’s new in stroke? The top 10 studies of 2006–2008. Part II

Six studies from 2006–2008 that have influenced clinical management of stroke and threatened stroke are presented. The ABCD2 score effectively stratifies the short-term risk of stroke following transient ischemic attack into those with a high (12%), moderate (6%), and low (1%) 7-day stroke risk. High-dose atorvastatin reduces recurrent stroke in patients with recent stroke, but probably slightly increases central nervous system hemorrhage (SPARCL). Intravenous tissue plasminogen activator is of overall benefit to selected patients when given 3 to 4.5 hours after ischemic stroke onset (ECASS III). Adjusted-dose warfarin is far superior to aspirin and is relatively safe for very old people with atrial fibrillation (BAFTA). Despite results from 3 recent randomized trials (SAPPHIRE, EVA-3S and SPACE) the optimal role of carotid angioplasty/stenting vs. endarterectomy remains unclear. Enoxaparin once daily is an efficacious alternative to unfractionated heparin twice daily for prevention of venous thromboembolism after acute ischemic stroke (PREVAIL). These recent studies add important pieces to the complex puzzle of optimal stroke prevention and treatment.