Medical Management for Secondary Stroke Prevention

Continuum (Minneap Minn). 2020 Apr;26(2):435-456. doi: 10.1212/CON.0000000000000849.

Abstract

Purpose of review: This article reviews the evidence base and recommendations for medical management for secondary stroke prevention.

Recent findings: Recent developments for secondary stroke prevention include evidence to support the use of short-term dual antiplatelet therapy after minor stroke and transient ischemic attack, direct oral anticoagulants for nonvalvular atrial fibrillation, reversal agents for direct oral anticoagulant-associated hemorrhage, and aspirin rather than presumptive anticoagulation with a direct oral anticoagulant for embolic stroke of undetermined source.

Summary: Most strokes are preventable. The mainstays of medical management for secondary stroke prevention include antihypertensive therapy; antithrombotic therapy, with antiplatelet agents for most stroke subtypes or anticoagulants such as warfarin or a direct oral anticoagulant for cardioembolic stroke specifically; cholesterol-lowering therapy, principally with statins, but with potential roles for ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors in selected patients; and glycemic control to prevent microvascular complications from diabetes mellitus or pioglitazone in selected patients with insulin resistance but not diabetes mellitus.

Publication types

  • Review

MeSH terms

  • Anticholesteremic Agents / administration & dosage*
  • Anticoagulants / administration & dosage*
  • Antihypertensive Agents / administration & dosage*
  • Fibrinolytic Agents / administration & dosage*
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Secondary Prevention* / methods
  • Secondary Prevention* / standards
  • Stroke / drug therapy
  • Stroke / etiology
  • Stroke / prevention & control*

Substances

  • Anticholesteremic Agents
  • Anticoagulants
  • Antihypertensive Agents
  • Fibrinolytic Agents
  • Hypoglycemic Agents
  • Platelet Aggregation Inhibitors