The risk of a second stroke can be reduced with prevention efforts based on the cause of the first stroke

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A blood clot that forms in the carotid artery. Credit: copyright American Heart Association

Having a stroke or a transient ischemic attack (TIA), sometimes called a “mini stroke,” increases the risk of having a stroke in the future. Identifying the cause of the stroke or TIA can lead to specific prevention strategies to reduce the risk of additional stroke, according to an updated guideline from the American Heart Association / American Stroke Association. The guideline is published today at Stroke.

Ischemic strokes account for 87% of strokes in the United States. An ischemic stroke occurs when in a vessel leading to the brain it is blocked by clots or plaques. Strokes can cause a severe disability and / or death. A , commonly known as TIA, occurs when an artery is blocked for a short period of time; therefore, the blockage is transient (temporary) and does not cause permanent brain injury.

As prevention strategies have improved, studies have noted a reduction in recurrent stroke rates from 8.7% in the 1960s to 5.0% in the 2000s. during a second stroke they remain poorly managed among stroke survivors.

A new recommendation of the “2021 Guide to Stroke Prevention in Patients with Stroke and Transient Ischemic Attack” is for perform diagnostic evaluations to determine the cause of the first stroke or TIA within 48 hours after the onset of symptoms. The guideline includes a section that lists treatment recommendations based on the cause of the initial stroke / TIA. The underlying causes could be related to blockages in the large arteries of the neck or brain, in the damaged small arteries of the brain. or diabetes, irregular heart rhythms and many other potential causes.

“It’s very important to understand the best ways to prevent another stroke once someone has had a stroke or a TIA,” said Dawn O. Kleindorfer, MD, FAHA, chair of the guide writing group and professor and chair of the department of Neurology at the University of Michigan School of Medicine in Ann Arbor, Michigan. “If we can identify the cause of the first stroke or TIA, we can adapt strategies to prevent a second stroke.”

In patients who have survived a stroke or TIA, secondary prevention guidelines recommend:

Manage your vascular risk factors, especially high blood pressure, as well as type 2 diabetes, cholesterol, triglyceride levels and no smoking.

Limit salt intake and / or follow a Mediterranean diet.

If they are able to do it , performing moderate-intensity aerobic activity for at least 10 minutes four times a week or vigorous-intensity aerobic activity for at least 20 minutes twice a week.

“In fact, approximately 80% of strokes can be prevented by controlling blood pressure, eating a healthy diet, exercising regularly, not smoking, and maintaining a healthy weight,” said Amytis Towfighi, MD, FAHA, group vice president of writing guidelines and director of neurological services at the Los Angeles County Department of Health Services.

For healthcare professionals, the updated treatment recommendations highlighted in the guide include:

Using multidisciplinary care teams to personalize patient care and employing shared decisions with the patient to develop care plans that incorporate the patient’s desires, goals, and concerns.

Detection and diagnosis of atrial fibrillation (an irregular heartbeat) and initiation of blood-thinning medications to reduce recurrent events.

Prescribe antithrombotic therapy, including antiplatelet (anticoagulant) or anticoagulant (to prevent blood clotting), for almost all patients who have no contraindications. However, the combination of antiplatelets and anticoagulants is usually not recommended to prevent a second stroke and short-term antiplatelet therapy is recommended in the short term, taking aspirin along with a second drug to prevent blood clotting, only for specific patients: those with lower early-onset stroke and high-risk TIA or severe symptomatic stenosis.

Carotid endarterectomy, surgical removal of a blockage, or, in some cases, the use of a carotid artery stent in patients with narrow arteries in the neck should be considered.

Aggressive medical treatment of risk factors and short-term dual antiplatelet therapy are preferred in patients with severe intracranial stenosis that is thought to cause stroke or TIA.

In some patients, it is now reasonable to consider percutaneous closure (a less invasive surgical procedure based on a catheter) a patent oval foramen, a small and fairly common heart defect.

The guideline is accompanied by a systematic review article, published simultaneously, “Benefits and Risks of Dual Antiplatelet Therapy Against Secondary Stroke Prevention.” The review paper, chaired by Devin L. Brown, MD, MS, is a meta-analysis of three short-term clinical trials on antiplatelet therapy (DAPT) and concludes that DAPT may be appropriate for selected patients. The authors of the review point out: “Additional research is needed to determine: the optimal time to start treatment in relation to the clinical event; the optimal duration of DAPT to maximize the risk-benefit relationship; if additional populations of DAPT are excluded. POINT and CHANCE [two of the trials examined], such as those with major stroke, may also benefit from early DAPT; and whether certain genetic profiles eliminate the benefit of early DAPT “.

“Secondary prevention of The guideline is one of the “flagship” guidelines of the American Stroke Association, which was last updated in 2014, “Kleindorfer added.” There are also a number of changes in the wording and format of this guideline to make it easier for professionals to understand and locate information. quickly, greatly improving patient care and preventing more strokes in our patients. ”


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More information:
Stroke (2021). DOI: 10.1161 / STR.0000000000000375

Citation: The risk of a second stroke can be reduced with prevention efforts based on the cause of the first stroke (2021, May 24) recovered on May 24, 2021 at https://medicalxpress.com/news/2021-05-efforts -based.html

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