Prevention of recurrent ischaemic stroke

August 2007

Recurrent ischaemic stroke and transient ischaemic attack are common problems in primary care, with stroke survivors averaging 10 outpatient visits per year

Risk factors such as hypertension, diabetes, and hypercholesterolaemia should be evaluated at each visit. Special attention should be given to lifestyle modification, including management of obesity, smoking cessation, reduction in alcohol consumption, and promotion of physical activity.

The choice of an antiplatelet agent (e.g. aspirin, ticlopidine, clopidogrel, dipyridamole) or the anticoagulant warfarin is based on the safety, tolerability, effectiveness, and price of each agent.

L. M. Dickerson and his colleagues from the Trident Medical Center/Medical University of South Carolina Family Medicine Residency Program, Charleston, South Carolina, USA, noted aspirin as the common first choice for prevention of recurrent stroke, but pointed out that the combination of dipyridamole and aspirin should be considered for many patients because of its superior effectiveness in two clinical trials.

The authors recommended clopidogrel for patients with aspirin intolerance or allergy, or for those who cannot tolerate dipyridamole. Warfarin and the combination of aspirin and clopidogrel should not be used in the prevention of ischaemic stroke.