Transient ischemic attack secondary prevention: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 20: Line 20:
*Initiation of statin for hyperlipidemia with goal LDL level<100mg/dl<ref name="pmid26920158">{{cite journal| author=Yaghi S, Elkind MS| title=Lipid Control and Beyond: Current and Future Indications for Statin Therapy in Stroke. | journal=Curr Treat Options Cardiovasc Med | year= 2016 | volume= 18 | issue= 4 | pages= 27 | pmid=26920158 | doi=10.1007/s11936-016-0448-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26920158  }} </ref><ref name="pmid16912978">{{cite journal| author=Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA et al.| title=National Stroke Association guidelines for the management of transient ischemic attacks. | journal=Ann Neurol | year= 2006 | volume= 60 | issue= 3 | pages= 301-13 | pmid=16912978 | doi=10.1002/ana.20942 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16912978  }} </ref>
*Initiation of statin for hyperlipidemia with goal LDL level<100mg/dl<ref name="pmid26920158">{{cite journal| author=Yaghi S, Elkind MS| title=Lipid Control and Beyond: Current and Future Indications for Statin Therapy in Stroke. | journal=Curr Treat Options Cardiovasc Med | year= 2016 | volume= 18 | issue= 4 | pages= 27 | pmid=26920158 | doi=10.1007/s11936-016-0448-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26920158  }} </ref><ref name="pmid16912978">{{cite journal| author=Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA et al.| title=National Stroke Association guidelines for the management of transient ischemic attacks. | journal=Ann Neurol | year= 2006 | volume= 60 | issue= 3 | pages= 301-13 | pmid=16912978 | doi=10.1002/ana.20942 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16912978  }} </ref>
====Antithrombotic stroke====
====Antithrombotic stroke====
*Long term antiplatelet therapy with aspirin, dipyrimadole plus aspirin, clopidogrel or aspirin alone<ref name="pmid27375548">{{cite journal| author=Yakhkind A, McTaggart RA, Jayaraman MV, Siket MS, Silver B, Yaghi S| title=Minor Stroke and Transient Ischemic Attack: Research and Practice. | journal=Front Neurol | year= 2016 | volume= 7 | issue=  | pages= 86 | pmid=27375548 | doi=10.3389/fneur.2016.00086 | pmc=4901037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27375548  }} </ref><ref name="pmid22931315">{{cite journal| author=SPS3 Investigators. Benavente OR, Hart RG, McClure LA, Szychowski JM, Coffey CS et al.| title=Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 9 | pages= 817-25 | pmid=22931315 | doi=10.1056/NEJMoa1204133 | pmc=4067036 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22931315  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23247951 Review in: Ann Intern Med. 2012 Dec 18;157(12):JC6-2] </ref><ref name="pmid23803136">{{cite journal| author=Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C et al.| title=Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 1 | pages= 11-9 | pmid=23803136 | doi=10.1056/NEJMoa1215340 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23803136  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24126666 Review in: Ann Intern Med. 2013 Oct 15;159(8):JC5]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24052397 Review in: Evid Based Med. 2014 Apr;19(2):58] </ref><ref name="pmid16912978">{{cite journal| author=Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA et al.| title=National Stroke Association guidelines for the management of transient ischemic attacks. | journal=Ann Neurol | year= 2006 | volume= 60 | issue= 3 | pages= 301-13 | pmid=16912978 | doi=10.1002/ana.20942 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16912978  }} </ref>
*Long term antiplatelet therapy with aspirin, dipyrimadole plus aspirin, clopidogrel or aspirin alone<ref name="pmid27375548">{{cite journal| author=Yakhkind A, McTaggart RA, Jayaraman MV, Siket MS, Silver B, Yaghi S| title=Minor Stroke and Transient Ischemic Attack: Research and Practice. | journal=Front Neurol | year= 2016 | volume= 7 | issue=  | pages= 86 | pmid=27375548 | doi=10.3389/fneur.2016.00086 | pmc=4901037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27375548 }} </ref><ref name="pmid16912978">{{cite journal| author=Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA et al.| title=National Stroke Association guidelines for the management of transient ischemic attacks. | journal=Ann Neurol | year= 2006 | volume= 60 | issue= 3 | pages= 301-13 | pmid=16912978 | doi=10.1002/ana.20942 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16912978 }} </ref><ref name="pmid22931315">{{cite journal| author=SPS3 Investigators. Benavente OR, Hart RG, McClure LA, Szychowski JM, Coffey CS et al.| title=Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 9 | pages= 817-25 | pmid=22931315 | doi=10.1056/NEJMoa1204133 | pmc=4067036 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22931315  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23247951 Review in: Ann Intern Med. 2012 Dec 18;157(12):JC6-2] </ref><ref name="pmid23803136">{{cite journal| author=Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C et al.| title=Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 1 | pages= 11-9 | pmid=23803136 | doi=10.1056/NEJMoa1215340 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23803136  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24126666 Review in: Ann Intern Med. 2013 Oct 15;159(8):JC5]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24052397 Review in: Evid Based Med. 2014 Apr;19(2):58] </ref>
*Anticoagulation not required
*Anticoagulation not required
====Cardioembolic stroke====
====Cardioembolic stroke====
*Anticoagualtion for atrial fibrillation with Vit K antagonist or NOACs.  
*Anticoagualtion for atrial fibrillation with Vit K antagonist or NOACs.  

Revision as of 21:43, 8 December 2016

Transient ischemic attack Microchapters

Home

Main Stroke Page

Ischemic stroke Page

Hemorrhagic Stroke Page

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Transient Ischemic Attack from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

CT

MRI

Echocardiography

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

AHA/ASA Guidelines for Stroke

Future or Investigational Therapies

Case Studies

Case #1

Transient ischemic attack secondary prevention On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Transient ischemic attack secondary prevention

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Transient ischemic attack secondary prevention

CDC on Transient ischemic attack secondary prevention

Transient ischemic attack secondary prevention in the news

Blogs on Transient ischemic attack secondary prevention

Directions to Hospitals Treating Transient ischemic attack

Risk calculators and risk factors for Transient ischemic attack secondary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Secondary prevention

The secondary prevention strategies for recurrent transient ischemic stroke and ischemic stroke may include the following:[1][2][3]

Life style modification for secondary prevention

Life style modification measures which may help reduce the risk of recurrent stroke and prevent complications may include:

  • Increased physical activity->10 min of exercise such as walking, running, bicycling or swimming >3 times/wk
  • Eating healthy balanced diet
  • Smoking cessation
  • Decreased alcohal intake

Treatment of modifiable risk factors

Blood pressure

  • BP control to less than 140/90mmHg or 130/90mm Hg with an angiotensin inhibitor alone or in combination with a diuretic or angiotensin receptor blocker[3]

Diabetes mellitus

  • Diabetes control with fasting blood glucose level <126mg/dl.[3]

Hyperlipidemia

  • Initiation of statin for hyperlipidemia with goal LDL level<100mg/dl[2][3]

Antithrombotic stroke

  • Long term antiplatelet therapy with aspirin, dipyrimadole plus aspirin, clopidogrel or aspirin alone[1][3][4][5]
  • Anticoagulation not required

Cardioembolic stroke

  • Anticoagualtion for atrial fibrillation with Vit K antagonist or NOACs.
  • If intolerant to anticoagulation, aspirin 325 mg or clopidogrel 75 mg (if aspirin intolerant)[3]

TIA with ongoing non Q wave MI or unstable angina

  • Use of aspirin(75 mg-100mg) in combination with clopidogrel (75 mg) may be beneficial.[3]

Other situations

  • Patients having history of TIA undergoing endartectomy may benefit from aspirin (25 to 325mg) before surgery.[3]

Secondary prevention for specific causes of transient ischemic stroke[6]

Cause of ischemic stroke Revascularization Multifactorial risk reduction
Carotid endartectomy Carotid stenting Other Surgical options Antiplatelet therapy Statins Antihypertensives Anticoagulants
Large artery disease Carotid Artery Stenosis ✔ ✔
Carotid occlusion ✔ ✔
Vertebral artery stenosis Angioplasty ✔ ✔ ✔
Large vessel atherosclerosis ✔ Percutaneous transluminal angioplasty ✔✔ ✔✔ ✔✔ ✔✔
Arterial dissection Endovascular surgical repair ✔ ✔
Cardiac embolism Atrial fibrillation ✔ ✔
Valvular heart disease ✔
Mitral valve disease ✔
Recent MI/ left ventricular thrombus ✔
Heart failure ✔ ✔
Dilated cardiomyopathy ✔ ✔
Hematological disorders Protein C/S deficiency ✔
Sickle cell disease Repeated blood transfusions and

Hydroxurea

✔
Antithrombin III deficiency ✔
Antiphospholipid antibody syndrome ✔ ✔

References

  1. ↑ 1.0 1.1 Yakhkind A, McTaggart RA, Jayaraman MV, Siket MS, Silver B, Yaghi S (2016). "Minor Stroke and Transient Ischemic Attack: Research and Practice". Front Neurol. 7: 86. doi:10.3389/fneur.2016.00086. PMC 4901037. PMID 27375548.
  2. ↑ 2.0 2.1 Yaghi S, Elkind MS (2016). "Lipid Control and Beyond: Current and Future Indications for Statin Therapy in Stroke". Curr Treat Options Cardiovasc Med. 18 (4): 27. doi:10.1007/s11936-016-0448-8. PMID 26920158.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA; et al. (2006). "National Stroke Association guidelines for the management of transient ischemic attacks". Ann Neurol. 60 (3): 301–13. doi:10.1002/ana.20942. PMID 16912978.
  4. ↑ SPS3 Investigators. Benavente OR, Hart RG, McClure LA, Szychowski JM, Coffey CS; et al. (2012). "Effects of clopidogrel added to aspirin in patients with recent lacunar stroke". N Engl J Med. 367 (9): 817–25. doi:10.1056/NEJMoa1204133. PMC 4067036. PMID 22931315. Review in: Ann Intern Med. 2012 Dec 18;157(12):JC6-2
  5. ↑ Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C; et al. (2013). "Clopidogrel with aspirin in acute minor stroke or transient ischemic attack". N Engl J Med. 369 (1): 11–9. doi:10.1056/NEJMoa1215340. PMID 23803136. Review in: Ann Intern Med. 2013 Oct 15;159(8):JC5 Review in: Evid Based Med. 2014 Apr;19(2):58
  6. ↑ Donnan GA, Fisher M, Macleod M, Davis SM (2008). "Stroke". Lancet. 371 (9624): 1612–23. doi:10.1016/S0140-6736(08)60694-7. PMID 18468545.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Transient_ischemic_attack_secondary_prevention&oldid=1275033"