BACKGROUND AND PURPOSE: Large multicenter trials have evaluated the benefit of different medical and surgical therapies to prevent @entity64 . However, the application of trial results to clinical practice remains uncertain for some areas of @entity64 prevention and has been discussed passionately among international experts. As part of a worldwide survey, the purpose of this analysis was to provide an informative and comparative view of the current practice of leading experts in North America (NA) and Western Europe (WE), where most of the large prevention trials have been performed. METHODS: The survey was performed worldwide among 185 neurologists who are currently leading the discussions of @entity64 prevention practices. It contained questions on the use of antiplatelet agents, oral anticoagulation, and surgery for the prevention of @entity385 . The population of this present analysis is the two groups of experts from WE (n=73) and NA (n=48) exclusively. RESULTS: Of each group, >90% responded to the survey. Nearly all respondents reported prescribing @entity117 in @entity1 at risk of @entity64 , but significant differences between NA and WE are shown by the recommended doses (P<.0001): @entity117 doses of >500 mg daily are given exclusively by American @entity1 (36%), whereas doses <200 mg are recommended only in Europe (51%). Eighty-six percent of American versus 59% of European respondents reported using @entity1396 as their second choice (P<.005), and 23% of respondents from WE used warfarin compared with 5% from NA (P<.05). The reported use of anticoagulants in @entity1 with @entity955 increased in accordance with the @entity1 's individual risk of @entity64 , but respondents from WE were more reluctant to use anticoagulants in @entity1 older than 75 years. Relatively higher target international normalized ratio values were reported by European respondents. Nearly all @entity1 recommend carotid endarterectomy in @entity1 with symptomatic @entity543 . The use of carotid endarterectomy in asymptomatic @entity1 was significantly more common among responding experts from NA (48% versus 28%; P<.05), particularly in @entity1 with >95% stenosis (89% versus 53%; P<.0005). CONCLUSIONS: This analysis shows significant differences in several areas of @entity64 prevention practices between leading experts from NA and WE. These differences may be explained partly by divergent results of trials from the two continents, but in some areas of controversy currently available trial data are not sufficient to form an international consensus to guide daily clinical practice.

Differences in medical and surgical therapy for XXXX prevention between leading experts in North America and Western Europe.

@entity1 :: ('9606', 'Species') :: ['participants', 'patients', 'patient'] @entity64 :: ('MESH:D020521', 'Disease') :: ['atherothrombotic stroke', 'stroke'] @entity1396 :: ('MESH:D013988', 'Chemical') :: ['ticlopidine'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['aspirin'] @entity955 :: ('MESH:D001281', 'Disease') :: ['atrial fibrillation'] @entity543 :: ('MESH:D016893', 'Disease') :: ['carotid stenosis'] @entity385 :: ('MESH:D002544', 'Disease') :: ['ischemic stroke']
@entity64 :: (MESH:D020521,Disease) :: ['stroke']
