Antiplatelet therapy in the prevention of recurrent ischemic stroke

Abstract

Stroke that includes both ischemic and hemorrhagic events is a major cause of death worldwide. It is currently the most common cause of disability. The risk of recurrence is the highest among cases where a recent stroke or transient ischemic attack was left untreated. In about 30% of these cases, a recurrent stroke leads to the worsening neurological symptoms or even death. Therefore, primary prevention of first stroke and secondary prevention of recurrent stroke are a top priority. Primary prevention of ischemic stroke includes lifestyle modification and diets, treatment of risk factors including hypertension, diabetes mellitus and lipid disorders, antiplatelet therapy for high vascular risk patients, and anticoagulation therapy in atrial fibrillation. Secondary prevention of ischemic stroke includes additional carotid surgery in symptomatic patients. Up to 90% of all strokes are preventable, and attributable to major modifiable risk factors. Optimal stroke prevention requires a harmonious, integrated approach to educating about stroke risk and healthy lifestyle, simple screening and management of patients for a history and presence of modifiable and treatable causal risk factors, and improving social and environmental factors. Intake of antiplatelet agents according to the subtype improves the prognosis of patients after an ischemic stroke or transient ischemic attack. Current data on stroke recurrence and mortality are important to examine trends, risk factors, and treatment effects.