Ischemic stroke secondary prevention: Difference between revisions
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*Use of long term antiplatelet therapy such as aspirin, clopidogrel or combination therapy may be used to prevent recurrent ischemic stroke.<ref name="pmid19121254">{{cite journal| author=Adams HP| title=Secondary prevention of atherothrombotic events after ischemic stroke. | journal=Mayo Clin Proc | year= 2009 | volume= 84 | issue= 1 | pages= 43-51 | pmid=19121254 | doi=10.1016/S0025-6196(11)60807-0 | pmc=2664570 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19121254 }} </ref> | *Use of long term antiplatelet therapy such as aspirin, clopidogrel or combination therapy may be used to prevent recurrent ischemic stroke.<ref name="pmid19121254">{{cite journal| author=Adams HP| title=Secondary prevention of atherothrombotic events after ischemic stroke. | journal=Mayo Clin Proc | year= 2009 | volume= 84 | issue= 1 | pages= 43-51 | pmid=19121254 | doi=10.1016/S0025-6196(11)60807-0 | pmc=2664570 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19121254 }} </ref> | ||
For AHA/ASA guidelines for prevention of stroke, please click here | 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:<ref name="pmid14683626">{{cite journal| author=Kappelle LJ, Van Der Worp HB| title=Treatment or prevention of complications of acute ischemic stroke. | journal=Curr Neurol Neurosci Rep | year= 2004 | volume= 4 | issue= 1 | pages= 36-41 | pmid=14683626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14683626 }} </ref><ref name="pmid20539816">{{cite journal| author=Anders J, Heinemann A, Leffmann C, Leutenegger M, Pröfener F, von Renteln-Kruse W| title=Decubitus ulcers: pathophysiology and primary prevention. | journal=Dtsch Arztebl Int | year= 2010 | volume= 107 | issue= 21 | pages= 371-81; quiz 382 | pmid=20539816 | doi=10.3238/arztebl.2010.0371 | pmc=2883282 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20539816 }} </ref> | |||
*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. | |||
*Proper positioning of pateint and use of nasogastric tube for feeding to prevent aspiration pneumonia in patients with cranial nerve palsies affecting pharyngeal motility and gag reflex<ref name="pmid23983842">{{cite journal| author=Armstrong JR, Mosher BD| title=Aspiration pneumonia after stroke: intervention and prevention. | journal=Neurohospitalist | year= 2011 | volume= 1 | issue= 2 | pages= 85-93 | pmid=23983842 | doi=10.1177/1941875210395775 | pmc=3726080 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23983842 }} </ref> | |||
*Pressure ulcers may be prevented by use of air mattress and regular change in position of patient<ref name="pmid20539816">{{cite journal| author=Anders J, Heinemann A, Leffmann C, Leutenegger M, Pröfener F, von Renteln-Kruse W| title=Decubitus ulcers: pathophysiology and primary prevention. | journal=Dtsch Arztebl Int | year= 2010 | volume= 107 | issue= 21 | pages= 371-81; quiz 382 | pmid=20539816 | doi=10.3238/arztebl.2010.0371 | pmc=2883282 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20539816 }} </ref> | |||
===Secondary prevention for specific causes of ischemic stroke<ref name="pmid18468545">{{cite journal| author=Donnan GA, Fisher M, Macleod M, Davis SM| title=Stroke. | journal=Lancet | year= 2008 | volume= 371 | issue= 9624 | pages= 1612-23 | pmid=18468545 | doi=10.1016/S0140-6736(08)60694-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18468545 }} </ref>=== | ===Secondary prevention for specific causes of ischemic stroke<ref name="pmid18468545">{{cite journal| author=Donnan GA, Fisher M, Macleod M, Davis SM| title=Stroke. | journal=Lancet | year= 2008 | volume= 371 | issue= 9624 | pages= 1612-23 | pmid=18468545 | doi=10.1016/S0140-6736(08)60694-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18468545 }} </ref>=== | ||
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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
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 alcohal 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.
- Proper positioning of pateint and use 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 | ✔ | ✔ | ||||||
Treatment of risk factors in patients who have already had strokes (secondary prevention) is also very important as they are at high risk of subsequent events compared with those who have never had a stroke. Medication or drug therapy is the most common method of stroke prevention. Aspirin (usually at a low dose of 75 mg) is recommended for the primary and secondary prevention of stroke. Also see Antiplatelet drug treatment. Treating risk factors like hypertension, diabetes mellitus, smoking cessation, control of hypercholesterolemia, physical exercise, and avoidance of illicit drugs and excessive alcohol consumption are all recommended ways of reducing the risk of stroke in a patient who already has a history of previous strokes.[6]
In patients who have strokes due to abnormalities of the heart, such as atrial fibrillation, anticoagulation with medications such as warfarin is often necessary for stroke prevention.[7]
Procedures such as carotid endarterectomy or carotid angioplasty can be used to remove significant atherosclerotic narrowing (stenosis) of the carotid artery, which supplies blood to the brain. These procedures have been shown to prevent stroke in certain patients, especially where carotid stenosis leads to ischemic events such as transient ischemic attack. (The value and role of carotid artery ultrasound scanning in screening has yet to be established.)
References
- ↑ 1.0 1.1 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.
- ↑ 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 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.
- ↑ American Heart Association. (2007). Stroke Risk Factors Americanheart.org. Retrieved on January 22, 2007.
- ↑ American Heart Association. (2007). Atrial Fibrillation Americanheart.org. Retrieved on January 22, 2007.