Med. praxi. 2015;12(1):8-12

Secondary prevention in patients surviving an ischemic stroke

prof.MUDr.Renata Cífková, CSc.^1,2,3, MUDr.Peter Wohlfahrt, Ph.D.^1,3, MUDr.Alena Krajčoviechová¹

¹ Centrum kardiovaskulární prevence, 1. lékařská fakulta, Univerzita Karlova v Praze a Thomayerova nemocnice, Praha

² II. interní klinika &ndash, klinika kardiologie a angiologie, 1. lékařská fakulta, Univerzita Karlova v Praze a VFN, Praha

³ Mezinárodní centrum klinického výzkumu, Brno

Etiologic classification of ischemic stroke helps to establish correct diagnosis and initiate optimal therapy. The European guidelines for

cardiovascular disease prevention and European Stroke Organization guidelines recommend, in patients with non-cardioembolic ischemic

stroke, either a combination of aspirin and dipyridamole or clopidogrel alone as first-line therapy. Recent US guidelines also recommend

aspirin alone as the drug of first choice. Patients with recent ischemic stroke and atrial fibrillation are at high risk of recurrent ischemic

stroke, and are indicated for anticoagulation therapy to be usually initiated within 14 days of symptom onset. Anticoagulation therapy

≥ 3 months is also recommended in patients after ischemic stroke, in sinus rhythm, and with thrombus formation in the left ventricle

or atrium. Antihypertensive medication is recommended in patients with ischemic stroke or TIA who, after the first several days, have

an established BP ≥ 140 mmHg systolic or BP ≥ 90 mmHg diastolic; all drugs can be used provided BP is effectively lowered. Current

guidelines agree in that statin therapy is recommended in patients with ischemic stroke.

Keywords: TOAST classification, acetylsalicylic acid (ASA), dipyridamole, clopidogrel, antihypertensive medication, statins

Published: February 27, 2015  Show citation