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J Clin Outcomes Manage
2004 Jun;11(6):371-382
The secondary prevention of ischemic stroke
Tabereaux PB, Brass LM, Bravata DM
OBJECTIVE: To provide an overview of the evidence and clinical approach to secondary stroke prevention for patients following an ischemic stroke or transient ischemic attack (TIA). METHODS: Overview of the literature. RESULTS: Patients with acute ischemic strokes and TIAs are at increased risk for secondary vascular events, including recurrent stroke. Nonmodifiable risk factors should be evaluated to identify patients who are at high risk of recurrent stroke. Risk factor modification includes diagnosing and treating hypertension, hyperlipidemia, and diabetes. Patients with high-grade symptomatic carotid artery stenosis should be evaluated for carotid endarterectomy. Stroke patients with atrial fibrillation should receive warfarin unless a contraindication is present. All other stroke patients should receive an antiplatelet agent unless contraindicated. Recommendations for lifestyle changes, including stopping smoking, avoiding heavy alcohol use, reducing overweight, and increasing exercise, should be made during the acute stroke period. CONCLUSION: Post-stroke care should involve an assessment of both nonmodifiable and modifiable risk factors in all patients. Risk factor modifications should be initiated early after the first event.
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