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 ischemic 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) | Favors intervention | Very Low |
Symptomatic pulmonary embolism (PE) (during treatment) | Favors intervention | High |
Recurrent ischemic or unknown etiology stroke (during treatment) | Favors intervention | Moderate |
Symptomatic intracranial hemorrhage (ICH) (during treatment) | Favors comparison | Moderate |
Any recurrent stroke/symptomatic ICH (during treatment) | No statistically significant difference | Moderate |
Major extracranial hemorrhage (ECH) (during treatment) | Favors 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 ischemic stroke. Due to the risks of hemorrhage even with low-dose subcutaneous regimens, the review authors recommend considering safer alternatives (e.g., aspirin, mechanical prophylaxis, early mobilization). The CCA and the Cochrane review noted that while anticoagulants reduce recurrent ischemic stroke, deep vein thrombosis, and pulmonary embolism, these benefits are offset by an increase in intracranial and extracranial hemorrhage. 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.
- Is there randomized controlled trial evidence to support the use of anticoagulants after acute ischemic stroke?
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- In people with aphasia following stroke, how does the use of speech and language therapy affect outcomes?
- Does electromechanical and robot‐assisted arm training improve generic activities of daily living, arm function, and arm strength in patients who have had a stroke?
- How does percutaneous endoscopic gastrostomy compare with nasogastric tube feeding in people with swallowing disturbances?
- How do cilostazol and aspirin compare for the prevention of vascular events after stroke of arterial origin?
- Can antibiotic therapy help to prevent infection in people with acute stroke?
- For adults with stroke, how does resistance training affect outcomes?
- For adults with stroke, how does cardiorespiratory training affect outcomes?
- Can caregiver-mediated exercise improve outcomes in people with stroke?
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