Transient ischemic attack secondary prevention: Difference between revisions
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Life style modification measures which may help reduce the risk of recurrent stroke and prevent complications may include: | Life style modification measures which may help reduce the risk of recurrent stroke and prevent complications may include: | ||
*Increased physical activity->10 min of exercise such as walking, running, bicycling or swimming >3 times/wk | *Increased physical activity->10 min of exercise such as walking, running, bicycling or swimming >3 times/wk | ||
*Eating healthy balanced diet | *Eating healthy balanced diet. Mediterranean diets are recommended for stroke risk reduction. | ||
*Smoking cessation | *Smoking cessation | ||
*Decreased | *Decreased alcohol intake | ||
*Controlling diseases that are risk factors, including diabetes, hyperlipidemia, and hypertension. | |||
===Treatment of modifiable risk factors=== | ===Treatment of modifiable risk factors=== | ||
Revision as of 22:10, 30 August 2022
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Transient ischemic attack Microchapters |
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Differentiating Transient Ischemic Attack from other Diseases |
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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
The secondary prevention strategies for recurrent transient ischemic stroke and ischemic stroke may include the lifestyle modification and treatment of modifiable risk factors.[1][2][3]
Secondary prevention
The secondary prevention strategies for recurrent transient ischemic stroke and ischemic stroke may include the following:[1][2][3]
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->10 min of exercise such as walking, running, bicycling or swimming >3 times/wk
- Eating healthy balanced diet. Mediterranean diets are recommended for stroke risk reduction.
- Smoking cessation
- Decreased alcohol intake
- Controlling diseases that are risk factors, including diabetes, hyperlipidemia, and hypertension.
Treatment of modifiable risk factors
Blood pressure
- BP control to less than 140/90mmHg or 130/90mm Hg with an angiotensin inhibitor alone or in combination with a diuretic or angiotensin receptor blocker[3]
Diabetes mellitus
- Diabetes control with fasting blood glucose level <126mg/dl.[3]
Hyperlipidemia
Antithrombotic stroke
- Long term antiplatelet therapy with aspirin, dipyrimadole plus aspirin, clopidogrel or aspirin alone[1][3][4][5]
- Anticoagulation not required
Cardioembolic stroke
- Anticoagualtion for atrial fibrillation with Vit K antagonist or NOACs.
- If intolerant to anticoagulation, aspirin 325 mg or clopidogrel 75 mg (if aspirin intolerant)[3]
TIA with ongoing non Q wave MI or unstable angina
- Use of aspirin(75 mg-100mg) in combination with clopidogrel (75 mg) may be beneficial.[3]
Other situations
- Patients having history of TIA undergoing endartectomy may benefit from aspirin (25 to 325mg) before surgery.[3]
Secondary prevention for specific causes of transient ischemic stroke[6]
| 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 for the secondary prevention of transient ischemic stroke, please click here
References
- ↑ 1.0 1.1 1.2 Yakhkind A, McTaggart RA, Jayaraman MV, Siket MS, Silver B, Yaghi S (2016). "Minor Stroke and Transient Ischemic Attack: Research and Practice". Front Neurol. 7: 86. doi:10.3389/fneur.2016.00086. PMC 4901037. PMID 27375548.
- ↑ 2.0 2.1 2.2 Yaghi S, Elkind MS (2016). "Lipid Control and Beyond: Current and Future Indications for Statin Therapy in Stroke". Curr Treat Options Cardiovasc Med. 18 (4): 27. doi:10.1007/s11936-016-0448-8. PMID 26920158.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA; et al. (2006). "National Stroke Association guidelines for the management of transient ischemic attacks". Ann Neurol. 60 (3): 301–13. doi:10.1002/ana.20942. PMID 16912978.
- ↑ SPS3 Investigators. Benavente OR, Hart RG, McClure LA, Szychowski JM, Coffey CS; et al. (2012). "Effects of clopidogrel added to aspirin in patients with recent lacunar stroke". N Engl J Med. 367 (9): 817–25. doi:10.1056/NEJMoa1204133. PMC 4067036. PMID 22931315. Review in: Ann Intern Med. 2012 Dec 18;157(12):JC6-2
- ↑ Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C; et al. (2013). "Clopidogrel with aspirin in acute minor stroke or transient ischemic attack". N Engl J Med. 369 (1): 11–9. doi:10.1056/NEJMoa1215340. PMID 23803136. Review in: Ann Intern Med. 2013 Oct 15;159(8):JC5 Review in: Evid Based Med. 2014 Apr;19(2):58
- ↑ 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.