Ischemic stroke secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
Secondary prevention of ischemic stroke is mainly directed to lifestyle modifications, treatment of modifiable risk factors, and treatment of specific cause of ischemic stroke.[1][2][3]
Secondary Prevention
Life style modification for secondary prevention
Life style modification measures which may help reduce the risk of recurrent stroke and prevent complications may include:
- Increased physical activity
- Eating healthy balanced diet
- Smoking cessation
- Decreased alcohol intake
Treatment of modifiable risk factors
- Treatment and maintainence of hypertension, diabetes mellitus and hyperlipidemias[1]
- Treatment of underlying coronary artery disease
- Treatment of atrial fibrillation and maintaining anticoagulant prophylaxis in high risk patients
- Proper management and follow up of genetic hypercoaguable conditions
- Use of long term antiplatelet therapy such as aspirin, clopidogrel or combination therapy may be used to prevent recurrent ischemic stroke.[1]
For AHA/ASA guidelines for prevention of stroke, please click here
Secondary prevention of complications of ischemic stroke
The preventive measures which may help prevent complications of ischemic stroke include:[2][3]
- Use of intermittent pneumatic compressions and low molecular weight heparin in patients with high risk of thromboembolism
- There is no prophylaxis for prevention of seizures in patients with ischemic stroke. However, one episode of seizure may mandate the use of antiepileptic medication to prevent recurrence.[2]
- Proper positioning of patient, and the use of thick feed with the help of nasogastric tube for feeding to prevent aspiration pneumonia in patients with cranial nerve palsies affecting pharyngeal motility and gag reflex[4]
- Pressure ulcers may be prevented by use of air mattress and regular change in position of patient[3]
Secondary prevention for specific causes of ischemic stroke[5]
| Cause of ischemic stroke | Revascularization | Multifactorial risk reduction | ||||||
|---|---|---|---|---|---|---|---|---|
| Carotid endartectomy | Carotid stenting | Other Surgical options | Antiplatelet therapy | Statins | Antihypertensives | Anticoagulants | ||
| Large artery disease | Carotid Artery Stenosis | ✔ | ✔ | |||||
| Carotid occlusion | ✔ | ✔ | ||||||
| Vertebral artery stenosis | Angioplasty | ✔ | ✔ | ✔ | ||||
| Large vessel atherosclerosis | ✔ | Percutaneous transluminal angioplasty | ✔✔ | ✔✔ | ✔✔ | ✔✔ | ||
| Arterial dissection | Endovascular surgical repair | ✔ | ✔ | |||||
| Cardiac embolism | Atrial fibrillation | ✔ | ✔ | |||||
| Valvular heart disease | ✔ | |||||||
| Mitral valve disease | ✔ | |||||||
| Recent MI/ left ventricular thrombus | ✔ | |||||||
| Heart failure | ✔ | ✔ | ||||||
| Dilated cardiomyopathy | ✔ | ✔ | ||||||
| Hematological disorders | Protein C/S deficiency | ✔ | ||||||
| Sickle cell disease | Repeated blood transfusions and
Hydroxurea |
✔ | ||||||
| Antithrombin III deficiency | ✔ | |||||||
| Antiphospholipid antibody syndrome | ✔ | ✔ | ||||||
For AHA/ASA guidelines on secondary prevention of ischemic stroke, please click here
References
- ↑ 1.0 1.1 1.2 Adams HP (2009). "Secondary prevention of atherothrombotic events after ischemic stroke". Mayo Clin Proc. 84 (1): 43–51. doi:10.1016/S0025-6196(11)60807-0. PMC 2664570. PMID 19121254.
- ↑ 2.0 2.1 2.2 Kappelle LJ, Van Der Worp HB (2004). "Treatment or prevention of complications of acute ischemic stroke". Curr Neurol Neurosci Rep. 4 (1): 36–41. PMID 14683626.
- ↑ 3.0 3.1 3.2 Anders J, Heinemann A, Leffmann C, Leutenegger M, Pröfener F, von Renteln-Kruse W (2010). "Decubitus ulcers: pathophysiology and primary prevention". Dtsch Arztebl Int. 107 (21): 371–81, quiz 382. doi:10.3238/arztebl.2010.0371. PMC 2883282. PMID 20539816.
- ↑ Armstrong JR, Mosher BD (2011). "Aspiration pneumonia after stroke: intervention and prevention". Neurohospitalist. 1 (2): 85–93. doi:10.1177/1941875210395775. PMC 3726080. PMID 23983842.
- ↑ Donnan GA, Fisher M, Macleod M, Davis SM (2008). "Stroke". Lancet. 371 (9624): 1612–23. doi:10.1016/S0140-6736(08)60694-7. PMID 18468545.