Once a patient has suffered a stroke, every effort should be made to prevent a recurrence. There is about a 10% chance of having a second stroke within one year.
Reduce risk factors for recurrence
Take the following actions to reduce risk factors:
- lower high blood pressure
- stop smoking
- control diabetes
- lower cholesterol
- maintain an average weight
- participate in moderate exercise such as walking or swimming 3 days per week for at least 30 minutes each session
Treat specific causes of stroke
Surgery for carotid artery stenosis
One cause of stroke is narrowing at the origin of the carotid artery from atherosclerosis. In the last 10 years, it has been proven that surgical repair of this artery significantly reduces the risk of another stroke occurring in a patient who has suffered either a transient ischemic attack (TIA) or a stroke affecting the side of the brain supplied by the diseased carotid artery. Without this surgery, the risk of another stroke over the following 2 years is 26%, compared with 9% when the surgery is performed.
Drug treatment for high-risk patients with atrial fibrillation (AF)
Atrial fibrillation (AF) is an irregular heartbeat that makes an individual more likely to have a stroke. AF causes about 10% of all strokes. It is now known that patients with AF and any one of the following characteristics are at high risk of stroke:
- age over 75, especially women
- diabetes
- high blood pressure
- previous transient ischemic attack (TIA) or stroke
- reduced pumping capacity of the heart
Recent studies have shown that people with AF and one of the above risks are best treated with a medication called warfarin. Warfarin thins the blood, so regular blood tests are required to monitor this. Studies show that in high-risk AF patients, warfarin works better than aspirin for thinning the blood and preventing stroke.
Use of blood thinners - antiplatelet therapy
Aspirin
Over 100 medical trials have now shown that aspirin prevents heart attacks and strokes in susceptible people who have already suffered a stroke or heart attack, or who have peripheral blood vessel disease. Aspirin works by preventing platelets, a type of blood cell, from forming blood clots. Everyone who has had a stroke or transient ischemic attack (TIA) should take aspirin to help prevent a second stroke. Most stroke experts agree that the exact dose of aspirin isn't too important - one aspirin per day, (80 mg to 325 mg) is sufficient, and even lower doses have been effective for preventing stroke.
Alternative antiplatelet medications
Two other antiplatelet medications have been approved in the United States for preventing stroke: ticlopidine (Ticlid®) and clopidogrel (Plavix®). These medications also work by preventing platelets from forming blood clots. Both medications are only slightly more effective than aspirin and are only recommended in patients who cannot tolerate aspirin. Clopidogrel has fewer side effects than ticlopidine and needs to be taken just once a day.