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Drugs in secondary stroke prevention

Chris Tremonti1, Mark Thieben2

  • 1Royal Prince Alfred Hospital, Sydney.

Australian Prescriber
|July 2, 2021
PubMed

Insights

Patients at high risk of recurrent stroke should receive secondary prevention. Key treatments include antiplatelet drugs, statins, and antihypertensives, tailored to individual patient needs and conditions like atrial fibrillation.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Ischaemic stroke and transient ischaemic attack (TIA) significantly increase the risk of subsequent cerebrovascular events.
  • Effective secondary stroke prevention strategies are crucial for reducing long-term morbidity and mortality.

Purpose of the Study:

  • To outline current evidence-based recommendations for secondary stroke prevention.
  • To detail pharmacological interventions for patients following ischaemic stroke or TIA.

Main Methods:

  • Review of established guidelines and clinical trial data on secondary stroke prevention therapies.
  • Analysis of treatment protocols for antiplatelet therapy, statins, and antihypertensives.

Main Results:

  • Antiplatelet therapy (aspirin, clopidogrel, or aspirin/dipyridamole combination) is recommended, with dual therapy limited to the initial three weeks post-stroke.
  • Anticoagulants are indicated for patients with atrial fibrillation; combinations with antiplatelet drugs should be avoided.
  • Statins are recommended at high doses for all patients post-ischaemic stroke, irrespective of baseline cholesterol levels.
  • Antihypertensive therapy is advised for patients with systolic blood pressure >140/90 mmHg, with ACE inhibitors, calcium channel blockers, and diuretics as first-line options.

Conclusions:

  • A multi-faceted approach combining antiplatelet agents, statins, and antihypertensives is essential for secondary stroke prevention.
  • Treatment strategies must be individualized based on stroke type, presence of atrial fibrillation, and blood pressure control.

Keywords:
anticoagulantsantiplatelet drugscerebrovascular diseasestroke

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