Transient ischemic attack 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]

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->10 min of exercise such as walking, running, bicycling or swimming >3 times/wk
• Eating healthy balanced diet
• Smoking cessation
• Decreased alcohal intake

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

Diabetes mellitus

• Diabetes control with fasting blood glucose level <126mg/dl.

Hyperlipidemia

• Initiation of statin for hyperlipidemia with goal LDL level<100mg/dl

Antithrombotic stroke

• Long term antiplatelet therapy with aspirin, dipyrimadole plus aspirin, clopidogrel or aspirin alone
• 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)

Secondary prevention for specific causes of transient ischemic stroke

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			✔			✔