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Abstract：
BACKGROUND: Different aspects of acute stroke management and strategies for stroke prevention derive from two viewpoints: specific traditional and historical backgrounds and evidence-based medicine from modern randomized controlled trials (RCTs), meta-analysis and authorized clinical practice guidelines (GLs). Regarding stroke, GLs have been published by national and international organizations in different languages, most frequently in English. Cerebrovascular Diseases published the European GLs for the management of ischemic stroke and transient ischemic attacks in 2003, with an update in 2008. At about the same time (in 2004), the first Japanese GLs for the management of stroke appeared in Japanese. The first English version of the updated Japanese GLs was published only in 2011 and included differently approved drugs and drug dosages as compared with other American or European countries.
METHODS: Since 2011, the authors have met repeatedly and have compared the latest versions of published European and Japanese GLs for ischemic and hemorrhagic strokes. Many aspects have only been addressed in one but left out in the other GLs, which consequently founded the basis for the comparison. Classification of evidence levels and recommendation grades defined by the individual committees differed between both original GLs.
RESULTS: Aspects of major importance were surprisingly similar and hence did not need extensive interpretation. Other aspects of ischemic stroke management differed significantly, e.g. the dosage of recombinant tissue plasminogen activator approved in Japan is lower (0.6 mg/kg) than in Europe (0.9 mg/kg), which derived from different practices in cardiovascular treatment prior to the design of acute ischemic stroke RCTs. Furthermore, comedication with neuroprotective agents (edaravone), intravenous anticoagulants (argatroban) or antiplatelet agents within 1-2 days after stroke onset is recommended in Japan but not in Europe. For cardioembolic stroke prevention, a major difference consists in a higher international normalized ratio target (2.0-3.0) in younger subjects versus in those >70 years (1.6-2.6), without age restrictions in Europe.
CONCLUSIONS: This brief survey - when compared with the lengthy original recommendations - provides a stimulating basis for an extended interest among Japanese and European stroke clinicians to learn from their individual experiences and to strengthen efforts for joint cooperation in treating and preventing stroke all around the globe.
METHODS: Since 2011, the authors have met repeatedly and have compared the latest versions of published European and Japanese GLs for ischemic and hemorrhagic strokes. Many aspects have only been addressed in one but left out in the other GLs, which consequently founded the basis for the comparison. Classification of evidence levels and recommendation grades defined by the individual committees differed between both original GLs.
RESULTS: Aspects of major importance were surprisingly similar and hence did not need extensive interpretation. Other aspects of ischemic stroke management differed significantly, e.g. the dosage of recombinant tissue plasminogen activator approved in Japan is lower (0.6 mg/kg) than in Europe (0.9 mg/kg), which derived from different practices in cardiovascular treatment prior to the design of acute ischemic stroke RCTs. Furthermore, comedication with neuroprotective agents (edaravone), intravenous anticoagulants (argatroban) or antiplatelet agents within 1-2 days after stroke onset is recommended in Japan but not in Europe. For cardioembolic stroke prevention, a major difference consists in a higher international normalized ratio target (2.0-3.0) in younger subjects versus in those >70 years (1.6-2.6), without age restrictions in Europe.
CONCLUSIONS: This brief survey - when compared with the lengthy original recommendations - provides a stimulating basis for an extended interest among Japanese and European stroke clinicians to learn from their individual experiences and to strengthen efforts for joint cooperation in treating and preventing stroke all around the globe.
摘要：
背景：急性卒中管理和卒中预防策略的不同方面来自两个观点：特定的传统和历史背景以及来自现代随机对照试验（RCT）的循证医学，荟萃分析和授权临床实践指南(GL)。关于中风，国家和国际组织以不同的语言出版了GL，最常见的是英语。2003年，《脑血管疾病》发表了欧洲治疗缺血性中风和短暂性脑缺血发作的GLs，2008年进行了更新。大约在同一时间（2004年），第一个用于中风管理的日本GL出现在日语中。更新的日本GL的第一个英文版仅在2011年发布，与其他美国或欧洲国家相比，包括不同的批准药物和药物剂量。
方法：自2011年以来，作者多次会面，并比较了最新版本的欧洲和日本已发表的用于缺血性和出血性中风的GLs。许多方面只在一个问题中得到了解决，但在其他问题中却被遗漏了，从而为比较奠定了基础。各个委员会定义的证据水平和建议等级的分类在两个原始GL之间有所不同。
结果：重要的方面令人惊讶地相似，因此不需要广泛的解释。缺血性卒中管理的其他方面存在显著差异，例如，日本批准的重组组织纤溶酶原激活剂的剂量（0.6mg/kg）低于欧洲（0.9mg/kg），这源于设计急性缺血性卒中RCT之前心血管治疗的不同实践。此外，使用神经保护剂（依达拉奉），在日本,建议在卒中发病后1~2天内静脉注射抗凝血剂(阿加曲班)或抗血小板药物,但欧洲不建议.对于心源性栓塞中风的预防，一个主要的区别在于年轻受试者的国际标准化比率目标（2.0-3.0）高于70岁（1.6-2.6），在欧洲没有年龄限制。
结论：这项简短的调查——与冗长的原始建议相比——为日本和欧洲卒中临床医生的广泛兴趣提供了一个刺激的基础，以学习他们的个人经历，并加强全球范围内在治疗和预防卒中方面的合作。
方法：自2011年以来，作者多次会面，并比较了最新版本的欧洲和日本已发表的用于缺血性和出血性中风的GLs。许多方面只在一个问题中得到了解决，但在其他问题中却被遗漏了，从而为比较奠定了基础。各个委员会定义的证据水平和建议等级的分类在两个原始GL之间有所不同。
结果：重要的方面令人惊讶地相似，因此不需要广泛的解释。缺血性卒中管理的其他方面存在显著差异，例如，日本批准的重组组织纤溶酶原激活剂的剂量（0.6mg/kg）低于欧洲（0.9mg/kg），这源于设计急性缺血性卒中RCT之前心血管治疗的不同实践。此外，使用神经保护剂（依达拉奉），在日本,建议在卒中发病后1~2天内静脉注射抗凝血剂(阿加曲班)或抗血小板药物,但欧洲不建议.对于心源性栓塞中风的预防，一个主要的区别在于年轻受试者的国际标准化比率目标（2.0-3.0）高于70岁（1.6-2.6），在欧洲没有年龄限制。
结论：这项简短的调查——与冗长的原始建议相比——为日本和欧洲卒中临床医生的广泛兴趣提供了一个刺激的基础，以学习他们的个人经历，并加强全球范围内在治疗和预防卒中方面的合作。
