Fast Five Quiz: Stroke

Richard H. Sinert, DO


November 06, 2020

"Primary prevention" refers to the management of individuals with no history of stroke. Preventive measures may include the use of antiplatelet agents, statins, smoking cessation, and exercise. "Secondary prevention" refers to the treatment of individuals who have already had a stroke. Measures may include the use of antiplatelet agents, anticoagulants (warfarin or newer novel oral anticoagulants) antihypertensives, statins, and lifestyle interventions.

With the advent of other novel anticoagulants, the American Academy of Neurology (AAN) produced guidelines for the prevention of stroke in nonvalvular atrial fibrillation. The guidelines recommend that clinicians should administer dabigatran, rivaroxaban, or apixaban to patients who have nonvalvular atrial fibrillation requiring anticoagulant medication and are at higher risk for intracranial bleeding; they also suggest that clinicians might offer apixaban to patients with nonvalvular atrial fibrillation and gastrointestinal bleeding risk who require anticoagulant medication. The AAN guidelines recommend that where oral anticoagulants are unavailable, clinicians might offer a combination of aspirin and clopidogrel. 

Overall, the value of aspirin in primary prevention appears uncertain, and its use for this purpose is not recommended for patients at low risk. The US Preventive Services Task Force recommends that adults aged 50-59 years begin taking daily low-dose aspirin if they have a 10% or greater 10-year cardiovascular disease risk, do not have bleeding risk factors, and are willing to take daily aspirin for at least 10 years. However, this recommendation has been called into question.  

Guidelines from the American Heart Association/American Stroke Association on the secondary prevention of stroke emphasize nutrition and lifestyle and recommend that in patients without deep venous thrombosis, a patent foramen ovale not be closed. In addition, because there are few data to suggest that the use of niacin or fibrate drugs to raise HDL cholesterol reduces secondary stroke risk, the guidelines no longer recommend their use.

Read more about stroke prevention.


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