ESO

ESO = European Stroke Organisation

The European Stroke Organisation was formed when the European Stroke Council (ESC) and the European Stroke Initiative (EUSI) merged in December of 2007. Members of the former EUSI writing committee and the ESO developed the 2008 ESO guidelines for stroke

ESO Guidelines for Secondary Stroke Prevention:
Antithrombotic Therapy (Antiplatelet and Oral Anticoagulation Therapies)

• It is recommended that patients receive antithrombotic therapy
  (Class I, Level A)
• It is recommended that patients not requiring anticoagulation should receive antiplatelet therapy (Class I, Level A) . Where possible, combined ASA and dipyridamole, or clopidogrel alone, should be given. Alternatively, ASA alone, or triflusal alone, may be used (Class I, Level A)
• The combination of ASA and clopidogrel is not recommended in patients with recent ischaemic stroke, except in patients with specific indications (e.g. unstable angina or non-Q-wave MI, or recent stenting); treatment should be given for up to 9 months after the event (Class I, Level A)
• It is recommended that patients who have a stroke on antiplatelet therapy should be re-evaluated for pathophysiology and risk factors (Class IV, GCP)
• Oral anticoagulation (INR 2.0–3.0) is recommended after ischaemic stroke associated with AF (Class I, Level A) . Oral anticoagulation is not recommended in patients with co-morbid conditions such as falls, poor compliance, uncontrolled epilepsy, or gastrointestinal bleeding (Class III, Level C). Increasing age alone is not a contraindication to oral anticoagulation (Class I, Level A)
• It is recommended that patients with cardioembolic stroke unrelated
  to AF should receive anticoagulants (INR 2.0-3.0) if the risk of recurrence is high (Class III, Level C)
• It is recommended that anticoagulation should not be used after non-cardioembolic ischaemic stroke, except in some specific situations, such as aortic atheromas, fusiform aneurysms of the basilar artery, cervical artery dissection, or patent foramen ovale in the presence of proven deep vein thrombosis (DVT) or atrial septal aneurysm
  (Class IV, GCP)
• It is recommended that combined low dose ASA and dipyridamole should be given if oral anticoagulation is contraindicated
  (Class IV, GCP)