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(Stroke. 1999;30:1991-1994.)
© 1999 American Heart Association, Inc.
AHA Scientific Statement |
Preventing Ischemic Stroke in Patients With Prior Stroke and Transient Ischemic Attack
A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association
Key Words: AHA Scientific Statements • stroke • ischemia • prevention
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Introduction |
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Stroke, the third leading cause of death in the United States, is a leading cause of adult neurological disability and accounts for the greatest number of hospitalizations for neurological disease. Although treatment of acute stroke has the potential of reducing death and disability, it is likely that prevention will more effectively reduce the ravages of stroke. The patient who is recovering from a mild stroke or who has had a recent transient ischemic attack (TIA) is at high risk of stroke recurrence, physical and intellectual disability, long-term institutionalization, and death.
There is substantial evidence from observational epidemiological
studies and clinical trials that recurrent ischemic stroke can
be prevented (Table 1
). Control of risk
factors is important for prevention of a first stroke and is practical
after ischemic stroke and TIA have occurred. Identification of
the specific ischemic stroke mechanism, eg, TIA or minor stroke
ipsilateral to a moderate or severe internal carotid stenosis,
guides decision making with regard to recurrent stroke prevention
therapy (Table 2). A patient with
symptomatic cerebrovascular disease is likely to have other
cardiovascular diseases or is predisposed to develop
them. Preventive measures should complement reduction in risk of
atherothrombotic events in the coronary arteries and other
arterial territories. Certain nonmodifiable characteristics
identify persons at high risk of stroke and stroke recurrence.
These include advancing age, male sex, and black and Hispanic
race-ethnic backgrounds. Some risk factors, however, such as elevated
blood pressure, cigarette smoking, obesity, impaired glucose tolerance,
and physical inactivity, are modifiable. Other
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 G. Syrbe, H. Redlich, B. Weidlich, J. Ludwig, S. Kopitzsch, A. Gockeritz, and K. Herzog Individual Dosing of ASA Prophylaxis by Controlling Platelet Aggregation Clinical and Applied Thrombosis/Hemostasis, July 1, 2001; 7(3): 209 - 213. [Abstract] [PDF]
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B. J. Quilliam, K. L. Lapane, and C. Leibson Clinical Correlates and Drug Treatment of Residents With Stroke in Long-Term Care Editorial Comment Stroke, June 1, 2001; 32(6): 1385 - 1393. [Abstract] [Full Text] [PDF]
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R. J. Adams Stroke Prevention and Treatment in Sickle Cell Disease Arch Neurol, April 1, 2001; 58(4): 565 - 568. [Full Text] [PDF]
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S. C. Johnston, D. R. Gress, W. S. Browner, and S. Sidney Short-term Prognosis After Emergency Department Diagnosis of TIA JAMA, December 13, 2000; 284(22): 2901 - 2906. [Abstract] [Full Text] [PDF]
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M. J. Alberts, G. Hademenos, R. E. Latchaw, A. Jagoda, J. R. Marler, M. R. Mayberg, R. D. Starke, H. W. Todd, K. M. Viste, M. Girgus, et al. Recommendations for the Establishment of Primary Stroke Centers JAMA, June 21, 2000; 283(23): 3102 - 3109. [Abstract] [Full Text] [PDF]
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Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke Stroke, April 1, 2000; 31(4): 1002 - 1012. [Full Text] [PDF]
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Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke Circulation, March 28, 2000; 101(12): 1483 - 1493. [Full Text] [PDF]
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M. S.V. Elkind Implications of stroke prevention trials: Treatment of global risk Neurology, July 12, 2005; 65(1): 17 - 21. [Abstract] [Full Text] [PDF]
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