Stroke
- Prevention

Primary prevention

Risk factors

• Atrial fibrillation (RR = 5)
• Hypertension (RR = 4)
• Smoking (RR = 4)
• Age (RR = 2)
• Diabetes (RR = 2)
• Cardiovascular disease (RR = 2)
• Hypercholesterolaemia (RR = 2)

Smoking and hypertension are the two most important modifiable risk factors.

Asymptomatic carotid stenosis

>75% stenosis is associated with 2% ipsilateral stroke per year.

Can consider carotid endarterectomy for patients who are medically fit and stenosis is severe.

 

Stroke and AF

Risk of stroke with non-valvular AF

• >65 y.o.
• Previous thromboembolic events
• Diabetes mellitus
• Hypertension
• LV dysfunction

No risk factors - <<1% risk of stroke per year.

At least one risk factors - 3-5% risk of stroke per year.

>65 y.o. AND at least one other risk factors - 6-12% risk of stroke per year.

 

Warfarin therapy carries a 1% risk of bleeding per year.

 

Secondary prevention

After a TIA or minor stroke, the risk of stroke is

• 5-7% per year.

Antiplatelet therapy

• First line: Aspirin 50-300mg
• Second line: dipyridamole+aspirin OR clopidogrel

Others

Carotid surgery - angioplasty/stenting for carotid stenosis

Warfarin for stroke associated with AF