Update on secondary prevention of ischaemic stroke

Stroke is becoming a major cause of morbidity and mortality in the developing world while the trend is actually downward in the developed nations. This is mostly because of the better recognition, treatment options and secondary prevention in addition to changes in lifestyles. There have been significant developments in the secondary prevention of ischaemic stroke in the last decade alone. Newer medications like direct thrombin inhibitors and factor Xa inhibitors have come into common practice. These medications are either equally effective or even better than age-old warfarin. Unlike previous belief, we now know that mechanical closure of the patent foramen ovale does not reduce the rate of stroke recurrence. There is a hint that dual anti-platelet therapy may reduce early recurrence of stroke. Even more exciting news is that closure of left atrial appendage might totally eliminate the need for oral anticoagulation in selected patient population.