Key result
Tailored medical management for secondary stroke prevention, including antiplatelets and anticoagulants, was discussed across 8 challenging patient scenarios.
This review provides case-based guidance on secondary stroke prevention in complex clinical scenarios.
May guide individualized antithrombotic strategies in complex secondary stroke prevention; leaves open the need for prospective validation.
The risk for recurrent stroke following a stroke or transient ischemic attack (TIA) is high. Prevention of a secondary event is a priority, as the associated morbidity and mortality are great. Antiplatelet agents have been shown to reduce this risk, but the choice of treatment modality depends on a number of factors, including the underlying cause of the stroke and the patient's comorbidities. For example, a cardioembolic stroke is best treated with anticoagulants, whereas one of noncardioembolic origin requires antiplatelet therapy. A number of challenging patient scenarios are explored in this article, and appropriate medical management is discussed, with the goal of examining the most recent trial data and information in the context of an actual case. Eight sample cases are presented: stroke prevention in a patient with recent stent placement, low ejection fraction, intracranial stenosis, carotid stenosis, atherosclerosis of the aortic arch, symptomatic coronary artery disease, antiplatelet failure, and stroke prevention in a patient already on warfarin. Journal of Hospital Medicine 2008;3(4 Suppl):S20–S28.
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Lee et al. (2008) conducted a review in Ischemic stroke or transient ischemic attack (TIA) (n=8). Antiplatelet and anticoagulant therapy was evaluated. Tailored medical management for secondary stroke prevention, including antiplatelets and anticoagulants, was discussed across 8 challenging patient scenarios.
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