Stroke: preventing recurrence

Once you have suffered a stroke, it's important to work with your doctor to reduce the chance that you will have another stroke. There is about a 10% chance of having a second stroke within one year.

Take the following actions to reduce risk factors:

  • lower high blood pressure
  • eat a diet rich in fruits, vegetables, and low-fat dairy products; and low in salt and saturated fat
  • control diabetes
  • lower cholesterol
  • quit smoking and avoid secondhand smoke
  • limit your alcohol intake to no more than 2 drinks a day for men and no more than 1 drink a day for women who aren't pregnant
  • participate in moderate exercise (enough to break a sweat or raise your heart rate) such as walking or swimming 1 to 3 days per week for at least 30 minutes each session (check with your doctor before starting a new exercise program)

Depending on your medical history, your doctor may also recommend other specific treatments to reduce your risk of having a second stroke, such as surgery, anticoagulant medications, antiplatelet medications, or statin medications.

Surgery

One cause of stroke is narrowing of a carotid artery (the carotid arteries are a pair of blood vessels that supply blood to the brain) from atherosclerosis (fatty deposits that harden and narrow the arteries). Surgery to repair this artery significantly reduces the risk of another stroke occurring for people who have suffered either a transient ischemic attack (TIA, a "mini-stroke" where symptoms last only a few minutes or hours) or a stroke affecting the side of the brain supplied by the diseased carotid artery. Without this surgery, the risk of another stroke over the following 2 years is 26%, compared with 9% when the surgery is performed.

Anticoagulant medications

Anticoagulant (blood thinner) medications such as warfarin reduce the risk of blood clots that could cause a stroke. Warfarin is often recommended for people who have had a stroke or TIA and also have one of the following medical conditions:

  • atrial fibrillation (a type of irregular heartbeat)
  • a blood clot in the heart after a heart attack
  • heart damage that reduces the pumping strength of the heart
  • an artificial heart valve
  • heart valve disease

Warfarin thins the blood, so regular blood tests are required to monitor this. In some cases, aspirin may be used for people who cannot take warfarin.

Antiplatelet medications

Antiplatelet medications help stop platelets from sticking together to form blood clots, which helps to reduce the risk of stroke. They are used to help prevent a second stroke for people who have already had a stroke or TIA, but do not have the medical conditions listed above. There are a number of antiplatelet medications available, including aspirin, aspirin plus dipyridamole (Aggrenox®), and clopidogrel (Plavix®).

Statins

Statins (e.g., lovastatin, rosuvastatin) are a type of cholesterol-lowering medication. They are recommended to reduce the risk of stroke in people with heart disease and those with evidence of atherosclerosis.

Reviewer: Trish Rawn, PharmD
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