Anti-inflammatory medications for preventing major heart events and strokes following ischaemic stroke (stroke due to a clot) or mini-stroke

Review question
Do anti-inflammatory medications have a role in preventing future serious heart conditions or stroke in people who have previously had a stroke or a transient ischaemic attack (TIA, or 'mini-stroke') as the result of a blood clot?

Background
Anti-inflammatory medications are used to reduce inflammation in several inflammatory conditions. Inflammation may be involved in the occurrence of stroke, mainly through the development of fatty deposits in the vessel (artery). Currently, a variety of medications are available to reduce the risk of heart attacks and strokes or mini-strokes, but 1 in 20 people will have a further stroke or heart attack.

Search date
Searching was complete on 29 May 2019.

Study characteristics
Eligible studies could involve any medication whose main use was anti-inflammatory in any setting in adult patients who had a previous stroke or TIA caused by a clot.

Key results
Although we conducted a thorough search of the medical literature for randomised controlled trials assessing anti-inflammatory medications versus no anti-inflammatory medications in people with previous stroke or TIA due to a blood clot, we were unable to identify any studies that had been conducted to explore this topic. Therefore, we cannot say whether anti-inflammatory medications alter heart and stroke outcomes following stroke due to a clot, or what the harms and benefits of this treatment might be. Trials are needed to compare the use of anti-inflammatory medications in combination with usual treatment versus usual treatment alone.

Quality of the evidence
No evidence and no studies were available.

Authors' conclusions: 

There is currently a paucity of evidence on the use of anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA. RCTs are needed to assess whether use of anti-inflammatory medications in this setting is beneficial.

Read the full abstract...
Background: 

An increasing body of evidence suggests that inflammation plays a key role in stroke, in particular stroke of atherosclerotic origin. Anti-inflammatory medications are a widely heterogeneous group of drugs that are used to suppress the innate inflammatory pathway and thus prevent persistent or recurrent inflammation. Anti-inflammatory agents have the potential to stabilise atherosclerotic plaques by impeding the inflammatory pathway. By targeting specific cytokines, the inflammatory pathway may be interrupted at various stages.

Objectives: 

To assess the benefits and harms of anti-inflammatory medications plus standard care versus standard care with or without placebo for prevention of vascular events (stroke, myocardial infarction (MI), non-fatal cardiac arrest, unstable angina requiring revascularisation, vascular death) and all-cause mortality in people with a prior history of ischaemic stroke or transient ischaemic attack (TIA).

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; last searched 29 May 2019); MEDLINE (1948 to 29 May 2019); Embase (1980 to 29 May 2019); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 29 May 2019); and Scopus (1995 to 29 May 2019). In an effort to identify additional published, unpublished, and ongoing trials, we searched several grey literature sources (last searched 30 May 2019). We incorporated all identified studies into the results section. We applied no restrictions with respect to language, date of publication, or study setting.

Selection criteria: 

We considered randomised controlled trials (RCTs) and cluster-randomised controlled trials that evaluated anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA.

Data collection and analysis: 

Two review authors independently assessed for inclusion titles and abstracts of studies identified by the search. Two review authors independently reviewed full-text articles for inclusion in this review. We planned to assess risk of bias and to apply the GRADE method.

Main results: 

We identified no studies that met the inclusion criteria.

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