Comparative Analysis of Latin American Guidelines for Acute Ischemic Stroke Diagnosis and Treatment

Introduction Stroke is the second leading cause of death and disability worldwide, with ischemic stroke the most common type (1). While risk increases with age, it also affects younger individuals, particularly those with hypertension, diabetes, or smoking history.Latin America (LATAM) bears a significant burden of this disease (2). Clinical Practice Guidelines (CPGs) are essential for improving stroke management; however, implementation in LATAM has been slow due to limited methodological rigor and resources (3). This study compares diagnostic and treatment recommendations of these guidelines in the region. Materials and Methods Using American Stroke Association/American Heart Association (ASA/AHA), Canadian Stroke Best Practice Recommendations (CSBPR), and European Stroke Organisation (ESO) guidelines as references, recommendations were classified into diagnosis and treatment.The protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42024506861) and follows Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines.Search strategy: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and additional sources using terms related to guidelines and ischemic stroke.All evidence‐based CPGs developed by recognized institutions in LATAM were included.Selection was conducted in two phases with duplicate review.Methodological quality was assessed with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and classified as “strongly recommended,” “recommended with modifications,” or “not recommended.”Diagnostic and treatment recommendations of LATAM CPGs were compared with reference guidelines, identifying discrepancies and areas for improvement. Results A total of 2,339 references were analyzed, selecting 63 and ultimately 6 evidence‐based guidelines produced between 2007 and 2018. They included 184 recommendations, mainly on diagnosis and treatment, with 50% developed by Ministries of Health.Quality assessment with AGREE II revealed three guidelines strongly recommended, one with adjustments, and two not recommended due to low quality. The domains of “scope and purpose” and “clarity of presentation” scored highest, while “applicability” scored lowest (4,5). The CSBPR guideline received the highest rating. Colombia stood out for its quality, while Cuba showed lowest methodological rigor.Comparisons revealed Colombia's CPG aligned most with CSBPR. Weaknesses included applicability and editorial independence. Few diagnostic recommendations and only one treatment recommendation coincided with Brazil, omitting tenecteplase, which CSBPR recommended. Conclusion Comparative analysis revealed discrepancies between CSBPR and LATAM CPGs for ischemic stroke, highlighting the need for updates every three years and inclusion of a methodological checklist.