Transient ischemic attack secondary prevention: Difference between revisions
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====Diabetes mellitus==== | ====Diabetes mellitus==== | ||
*Diabetes control with fasting blood glucose level <126mg/dl | *Diabetes control with fasting blood glucose level <126mg/dl or HbA1C < 7% or < 7%-8% | ||
====Hyperlipidemia==== | ====Hyperlipidemia==== | ||
*Initiation of statin for hyperlipidemia with goal LDL level<100mg/dl<ref name="pmid26920158">{{cite journal| author=Yaghi S, Elkind MS| title=Lipid Control and Beyond: Current and Future Indications for Statin Therapy in Stroke. | journal=Curr Treat Options Cardiovasc Med | year= 2016 | volume= 18 | issue= 4 | pages= 27 | pmid=26920158 | doi=10.1007/s11936-016-0448-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26920158 }} </ref><ref name="pmid16912978">{{cite journal| author=Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA et al.| title=National Stroke Association guidelines for the management of transient ischemic attacks. | journal=Ann Neurol | year= 2006 | volume= 60 | issue= 3 | pages= 301-13 | pmid=16912978 | doi=10.1002/ana.20942 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16912978 }} </ref> | *Initiation of statin for hyperlipidemia with goal LDL level<100mg/dl<ref name="pmid26920158">{{cite journal| author=Yaghi S, Elkind MS| title=Lipid Control and Beyond: Current and Future Indications for Statin Therapy in Stroke. | journal=Curr Treat Options Cardiovasc Med | year= 2016 | volume= 18 | issue= 4 | pages= 27 | pmid=26920158 | doi=10.1007/s11936-016-0448-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26920158 }} </ref><ref name="pmid16912978">{{cite journal| author=Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA et al.| title=National Stroke Association guidelines for the management of transient ischemic attacks. | journal=Ann Neurol | year= 2006 | volume= 60 | issue= 3 | pages= 301-13 | pmid=16912978 | doi=10.1002/ana.20942 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16912978 }} </ref> | ||
Revision as of 22:12, 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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Transient ischemic attack secondary prevention On the Web |
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American Roentgen Ray Society Images of Transient ischemic attack secondary prevention |
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Risk calculators and risk factors for Transient ischemic attack secondary prevention |
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 130/80mm 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 or HbA1C < 7% or < 7%-8%
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 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.