Pakistan Ischemic Stroke Guidelines

Abstract

Stroke is the second most common cause of morbidity and death globally, and even with great advancements in prevention and treatment techniques, the burden is still high worldwide¹. Stroke related mortality and morbidity is particularly high in countries with low and moderate incomes(LMIC). In 2016, number of death reported from stroke was  very high (56%) in countries with low and moderate incomes  compared with high-income countries (HICs) where it was only 29% ².True prevalence of stroke in Pakistan is not exactly known because of lack of  epidemiological studies.³ Integrated  population and health survey from Khyber Pakhtunkhwa determined the estimated stroke prevalence of 1.2% in KP province of Pakistan⁴. In Pakistan, risk factors of stroke in Pakistan are enormous. According to a cross-sectional study conducted at a community health center, 39% of adults over the age of 18 have a history of active smoking, hypertension, or dyslipidemia. The same study found that 42% of the individuals had a positive family history of ischemic heart disease, 24% were obese, 19% had hypertension, and 15% had diabetes mellitus.⁵. Majority of patients with stroke first consult general practitioner in Pakistan. Existing evidence-based guidelines for managing acute ischemic strokes are applicable in those areas where CT scan facility is available and can be applied in many areas of Pakistan with minimal level of resource availability and where District Hospitals lack the facility of neuroimaging. These guidelines will focus on acute ischemic stroke and its secondary prevention.