Management of patients after ischemic stroke

Abstract

Rehabilitation and secondary prevention of ischemic stroke (IS) is the basis for the management of patients with ischemic stroke. The important role of non-drug methods of secondary prevention of IS should be noted: cessation of smoking and alcohol abuse, regular physical activity, proper nutrition, reduction of excess body weight. The normalization of blood pressure is one of the most effective areas of IS prevention. It is based on the regular intake of antihypertensive drugs in most cases. After noncardioembolic IS, antiplatelet agents are required: acetylsalicylic acid (ASA), clopidogrel, or a combination of dipyridamole and ASA. The possibility of taking a combination of clopidogrel and ASA for 21 days after IS with a subsequent switch to monotherapy with ASA or clopidogrel is discussed in patients with non-disabling IS. After cardiomoembolic IS, warfarin is required under the control of an international normalized ratio or with nonvalvular atrial fibrillation of new oral anticoagulants: apixaban, dabigatran or rivaroxaban. Most patients after IS require statins, and the doses are selected individually. Carotid endarterectomy is most effective in severe stenosis (narrowing of 70–99% of the diameter) of the internal carotid artery on the side of the involved hemisphere during the first 3–7 days after non-disabling IS. The data of multicenter placebo-controlled and open observational studies on the use of the metabolic drug Cytoflavin, which is widely used in our country in the rehabilitation of patients with IS, are presented.