Cause of First Stroke Guides Prevention of Second Stroke

In a guideline issued by the American Heart Association/American Stroke Association and published online in Stroke, recommendations are presented for prevention of a second stroke.

Dawn O. Kleindorfer, MD, from the University of Michigan in Ann Arbor, and colleagues explore strategies for secondary stroke prevention among individuals who have had a stroke or transient ischemic attack (TIA).

The authors note that specific recommendations for prevention strategies depend on the subtype of the ischemic stroke/TIA. To reduce the risk for recurrent stroke, recommendations are provided for the diagnostic workup to define stroke etiology. Management of vascular risk factors is important in secondary stroke prevention, including diabetes, smoking cessation, lipids, and hypertension. Intensive medical management is usually best, with therapy tailored to the individual patient. For preventing second stroke, lifestyle factors are important, including healthy diet and physical activity. Programs that use models of behavior change, proven techniques, and multidisciplinary support are needed for changing patient behaviors. Nearly all patients without contraindications should receive antithrombotic therapy. The combination of antiplatelets and anticoagulation is typically not indicated for secondary stroke prevention with very few exceptions. Atrial fibrillation is a common and high-risk condition for second stroke; anticoagulation is usually recommended for management.

“It is critically important to understand the best ways to prevent another stroke once someone has had a stroke or a TIA,” Kleindorfer said in a statement. “If we can pinpoint the cause of the first stroke or TIA, we can tailor strategies to prevent a second stroke.”

Several authors disclosed financial ties to the biopharmaceutical, medical device, and other industries.

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