Recommendations to prevent stroke

This paper gave recommendations for preventing stroke among patients who survived an ischemic stroke or transient ischemic attack. 

A stroke occurs when there is not enough blood supply to the brain. In ischemic stroke, a blockage of a blood vessel to the brain leads to obstructed blood flow. In a transient ischemic attack, there is a temporary obstruction of blood to the brain. People who have had a transient ischemic attack are more likely to have a stroke in the future. Thus, prevention of stroke is very important among survivors. 

For patients with high blood pressure, medication should be given. Studies found that drugs for high blood pressure reduced the risk of stroke happening again by 22%. For patients with high levels of cholesterol (a fatty substance that builds up in the blood vessels), they should receive statin treatment to reduce cholesterol levels. One study found patients who received atorvastatin (a type of statin drug) had a 16% decreased risk of stroke compared to patients who did not receive atorvastatin. Patients should also make lifestyle and diet changes. One study found that lifestyle changes decreased the occurrence of diabetes (a risk factor for stroke) by 58%.

Carotid endarterectomy is recommended for patients with narrowed carotid arteries. This procedure involves the removal of plaque from the carotid artery. Aspirin is recommended for patients who had a stroke due to narrowing of an artery. An addition of clopidogrel (Plavix) to aspirin is recommended for patients who have severe narrowing of the arteries. Aspirin and clopidogrel work by preventing blood from sticking together and allows blood to flow smoothly. For patients with irregular heartbeat, they should receive appropriate medical therapy such as warfarin (Coumadin), rivaroxaban (Xarelto), aspirin or other drugs. Drugs like wafarin are recommended for patients with prosthetic heart valve.

For patients with non-cardioembolic ischemic stroke (stroke that is not caused by blood clot from heart) or transient ischemic attack, the use of antiplatelet drugs (such as aspirin) rather than anticoagulation drugs (such as wafarin) is recommended. Overall, medication should depend on each patient’s individual needs. 

The authors concluded that it is important for patients to receive appropriate treatment to prevent stroke from occurring.