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[Secondary stroke prevention]
J M Ferro1, M Correia, A Freire
1Serviço de Neurologia, Hospital de Santa Maria/Faculdade de Medicina de Lisboa.
Insights
These guidelines detail secondary stroke prevention strategies, including lifestyle changes, medications like antiplatelets and anticoagulants, and surgical options for carotid stenosis. Adherence improves outcomes for stroke and TIA survivors.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Context:
- Stroke and Transient Ischemic Attack (TIA) represent significant public health challenges.
- Effective secondary prevention is crucial to reduce recurrence and improve patient outcomes.
Purpose:
- To present evidence-based guidelines for secondary stroke prevention.
- To define stroke and TIA and establish referral indications.
- To outline diagnostic assessments and therapeutic recommendations.
Summary:
- Guideline recommendations encompass lifestyle modifications (diet, exercise, smoking/alcohol cessation), risk factor management (blood pressure, cholesterol), and antithrombotic therapy.
- Oral anticoagulants are indicated for atrial fibrillation and high-risk cardiac conditions; antiplatelet agents (aspirin, clopidogrel, etc.) are recommended for other ischemic events.
- Carotid endarterectomy is advised for symptomatic carotid stenosis exceeding 80%.
Impact:
- Implementation of these guidelines can significantly decrease stroke recurrence rates.
- Standardized diagnostic and treatment protocols enhance patient care and long-term prognosis.
- Promoting healthier lifestyles and targeted therapies reduces the burden of cerebrovascular disease.
Abstract:
The guidelines for secondary stroke prevention, graded following available scientific evidence, are presented. Stroke and TIA are defined and the indications for referral established. Basic assessment of stroke patients should include laboratory evaluation, ECG, brain CT, ultrasound examination of the extracranial vessels for events in the carotid distribution, and transthoracic or transesophageal echocardiogram if cardioembolism is suspected. The pharmacological and non-pharmacological reduction of blood pressure and serum cholesterol, stopping smoking and reducing alcohol intake are general measures recommended for secondary stroke prevention, together with healthier life-style changes (eating a Mediterranean type diet and performing regular moderate physical exercise). Concerning antithrombotic therapy, oral anticoagulants are recommended for patients with atrial fibrillation and other high to medium emboligenic cardiac risk conditions. Antiplatelet drugs are recommended for all other survivors of an ischemic cerebral event. Aspirin (75-325 mg/day) is the drug of choice. Alternative antiplatelet agents are clopidrogrel, ticlopidine, dipiridamol or triflusal. They can be used in patients with intolerance or contraindication to aspirin or in high-risk subjects. Endarterectomy of the symptomatic carotid is an additional procedure recommended for patients with ischemic stroke or TIA and carotid stenosis > 80% on the side of the symptomatic cerebral hemisphere.