AHA/ASA guideline recommendations for prevention of stroke in women prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]

2014 AHA/ASA Guideline Recommendations for Prevention of Stroke in Women (DO NOT EDIT)[1]

Class I
"1. Women with asymptomatic carotid stenosis should be screened for other treatable risk factors for stroke, and appropriate lifestyle changes and medical therapies should be instituted.[2] (Level of Evidence: C) "
"2. In women who are to undergo CEA, aspirin is recommended unless contraindicated, because aspirin was used in every major trial that demonstrated efficacy of CEA. (Level of Evidence: C) "
"3. For women with recent TIA or ischemic stroke within the past 6 months and ipsilateral severe (70%–99%) carotid artery stenosis, CEA is recommended if the perioperative morbidity and mortality risk is estimated to be <6%. (Level of Evidence: A) "
"4. For women with recent TIA or IS and ipsilateral moderate (50%–69%) carotid stenosis, CEA is recommended depending on patient-specific factors, such as age and comorbidities, if the perioperative morbidity and mortality risk is estimated to be <6%.[3] (Level of Evidence: B) "
"5. If a high-risk (ie, 10-year predicted CVD risk ≥10%) woman has an indication for aspirin but is intolerant of aspirin therapy, clopidogrel should be substituted.[4] (Level of Evidence: B) "
Class IIa
"1. Prophylactic CEA performed with <3% morbidity/mortality can be useful in highly selected patients with an asymptomatic carotid stenosis (minimum 60% by angiography, 70% by validated Doppler ultrasound). (Level of Evidence: A) "
"2. When CEA is indicated for women with TIA or stroke, surgery within 2 weeks is reasonable rather than delaying surgery, if there are no contraindications to early revascularization.[3] (Level of Evidence: B) "
"3. Aspirin therapy (75–325 mg/d) is reasonable in women with diabetes mellitus unless contraindicated.[4] (Level of Evidence: B) "
"4. Aspirin therapy can be useful in women ≥65 years of age (81 mg/d or 100 mg every other day) if BP is controlled and the benefit for IS and MI prevention is likely to outweigh the risk of gastrointestinal bleeding and hemorrhagic stroke.[4] (Level of Evidence: B) "
Class IIb
"1. Aspirin therapy may be reasonable for women <65 years of age for IS prevention. (Level of Evidence: B) "


  1. Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL; et al. (2014). "Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. doi:10.1161/01.str.0000442009.06663.48. PMID 24503673.
  2. Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S; et al. (2011). "Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 42 (2): 517–84. doi:10.1161/STR.0b013e3181fcb238. PMID 21127304.
  3. 3.0 3.1 Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC; et al. (2011). "Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association". Stroke. 42 (1): 227–76. doi:10.1161/STR.0b013e3181f7d043. PMID 20966421.
  4. 4.0 4.1 4.2 Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM; et al. (2011). "Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the american heart association". Circulation. 123 (11): 1243–62. doi:10.1161/CIR.0b013e31820faaf8. PMC 3182143. PMID 21325087.