and 1 other(s)
Background: Covert strokes (CS, previously ‘silent’ strokes) are parenchymal lesions which are present on neuroimaging but not associated with acute symptoms. These lesions have been associated with cognitive dysfunction, memory impairment/dementia, depression, gait disturbances, subsequent symptomatic stroke and early mortality. Current stroke guidelines recommend primary prevention interventions for CS. A systematic review of the evidence would assist clinicians and guideline developers. Methods: We searched Pubmed and Cochrane Review Libraries (April, 1970 to March, 2018) for randomized/non-randomized controlled studies or observational studies which assessed medical interventions for the prevention of CS, as detected by MRI or CT. The Jadad score was calculated where appropriate. Results: Twenty-one studies were found of which 14 were randomized controlled trials, 2 were non-randomized controlled trials and 8 were observational cohort studies. Inconsistent definitions of the endpoint were used and study quality was variable (Jadad scores: mean 3.7, IQR = 1). The most common intervention tested was an antithrombotic for prior overt stroke/atrial fibrillation or blood transfusion/hydroxyurea for sickle cell. Most trials were small, targeted specific populations, and suffered from short follow-up periods and loss to follow up. Conclusions: Limited evidence exists to guide clinicians seeking to prevent covert vascular disease of the brain. Future trials should use consistent and well-defined criteria for CS, be properly powered and randomized, and involve broader populations.
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