Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and there is no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Adults with presumed acute ischaemic stroke
Intervention: Anticoagulation
Comparison: Control (placebo [16 trials], aspirin alone [3 trials], standard-dose recombinant tissue plasminogen activator [rtPA] alone [2 trials], or no treatment [7 trials])
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Dead or dependent (final follow-up: >1 month) | No statistically significant difference | High |
All‐cause mortality (during treatment) | No statistically significant difference | Low |
All‐cause mortality (final follow-up: >1 month) | No statistically significant difference | Moderate |
Deep vein thrombosis (during treatment) | Favours intervention | Very Low |
Symptomatic pulmonary embolism (PE) (during treatment) | Favours intervention | High |
Recurrent ischaemic or unknown aetiology stroke (during treatment) | Favours intervention | Moderate |
Symptomatic intracranial haemorrhage (ICH) (during treatment) | Favours comparison | Moderate |
Any recurrent stroke/symptomatic ICH (during treatment) | No statistically significant difference | Moderate |
Major extracranial haemorrhage (ECH) (during treatment) | Favours comparison | Moderate |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) noted that the data does not support the routine use of early high-dose intravenous or subcutaneous anticoagulants in any form for people with acute ischaemic stroke. Due to the risks of haemorrhage even with low-dose subcutaneous regimens, the review authors recommend considering safer alternatives (e.g., aspirin, mechanical prophylaxis, early mobilisation). The CCA and the Cochrane review noted that while anticoagulants reduce recurrent ischaemic stroke, deep vein thrombosis, and pulmonary embolism, these benefits are offset by an increase in intracranial and extracranial haemorrhage. The CCA and Cochrane review noted that the results should be interpreted with caution due to short follow-up times (<1 year with half of the included studies ≤1 month) and methodological limitations of the studies including publication bias. Results were also dominated by a large single trial (19,435 of the 24,025 [81%] participants included in the review) which only recruited people aged 70 years or older and had unclear blinding.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What is the accuracy of prehospital stroke scales as screening tools for early detection of stroke and transient ischemic attacks (TIAs)?
- How does organized inpatient care compare with care on a general medical ward for people with stroke?
- Is there randomized controlled trial evidence to support the use of anticoagulants after acute ischemic stroke?
- How does very early mobilization compare with standard care after stroke?
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