1. What is secondary prevention?
Like other diseases, stroke prevention is divided into primary prevention and secondary prevention. Primary prevention is the search and removal of risk factors, while secondary prevention is the prevention and control measures to prevent recurrence of stroke after one acute stroke event (including TIA, cerebral infarction, etc.). A large number of clinical studies at home and abroad have shown that secondary prevention is the only effective way to reduce stroke morbidity, mortality and recurrent stroke.
2. What is the need for secondary prevention?
China is a major stroke country, with the second highest stroke prevalence rate in the world and the first highest recurrence rate of stroke patients in the world. The annual incidence rate of stroke in China is 150/100,000 and the death rate is 120/100,000. Based on this, there are 1.95 million new cases of stroke, 1.56 million deaths from stroke, and 5-7 million surviving stroke patients each year. The cost of inpatient medication for new stroke patients is 9.75 billion RMB per year.
In order to effectively organize and utilize the limited medical resources in China, to provide timely and accurate diagnosis and effective and safe treatment for stroke patients, to change the traditional concept of treating rather than preventing stroke, and to control the spread of stroke in China, the Chinese Physicians Association has recently launched the China Stroke Center Project, which is a systematic project to prevent and treat stroke.
3.How to carry out secondary prevention?
(1) Control the risk factors caused by diseases: hypertension, diabetes, heart valve disease, heart rhythm disorders, hypercoagulability of blood, hyperfibrinogenemia, hyperlipidemia, hyperplatelet aggregation, hyperhomocysteinemia, etc. are now considered as independent risk factors for stroke, and active treatment of related diseases is itself a preventive treatment for stroke.
(2) Improving poor lifestyle habits is also an important measure for secondary stroke prevention. For example, avoid high-fat, high-sugar and high-salt diets, and stop smoking and drinking.
(3) Use antiplatelet drugs (e.g. aspirin, etc.) for lesions of vascular origin and anticoagulant drugs (e.g. Warfarin, etc.) for lesions of cardiac origin.
(4) Regular neurological examinations and necessary auxiliary examinations and laboratory tests.
(5) Strengthen exercise according to their own condition, and provide health education to patients and their families.
4.Why are antiplatelet drugs significant in secondary prevention?
Large-scale clinical studies have shown that in patients with previous occlusive vascular events, aspirin can reduce the incidence of serious vascular events by 25%. While aspirin achieved such a large beneficial effect, it only mildly increased the absolute risk of hemorrhagic stroke (0.3 per 1,000). Thus, the benefit from aspirin prevention in high-risk patients far outweighs the possible small risk.
In the secondary prevention of cerebrovascular disease, antiplatelet agents play an important role. A total of 142 clinical trials with 73,000 patients are included in the studies currently reported on the use of antiplatelet agents to prevent stroke recurrence, and each study confirmed the secondary prevention role of antiplatelet agents.
5. What are the common misconceptions about secondary prevention of stroke?
Fear of adverse effects of aspirin and lack of confidence in the benefits of long-term aspirin therapy are the main reasons why patients do not adhere to long-term aspirin therapy, but inadequate drug therapy will lead to increased mortality in these patients at high cardiovascular risk. For example, there is no scientific basis for the perception that elderly patients give up aspirin therapy because they are more concerned about the adverse effects of aspirin, or even that many patients and their families believe that infusions every six months will prevent recurrence of cerebral infarction. In fact, this practice brings unnecessary suffering to patients and at the same time causes a lot of pharmaceutical waste. Therefore, it is very important to strengthen the education of patients on secondary prevention of stroke.
6.What are the commonly used antiplatelet drugs in clinical practice?
(1) Cyclooxygenase inhibitors: aspirin
(2) Phosphodiesterase inhibitors: Pansentin, Pepeda
(3) Inhibition of ADP-induced platelet aggregation: ticlopidine (Valtrex), clopidogrel (Polivir)
(4) Intravenous antiplatelet drugs: Ozagrel
7. What is the secondary prevention for stroke patients with cardiogenic embolism?
All types of heart disease are closely related to stroke. The risk of stroke is more than 2 times higher in people with heart disease than in people without heart disease, especially in patients with atrial fibrillation. Recommendations.
(1) Adults (>=40) should have regular medical checkups for early detection of heart disease.
(2) Patients with confirmed heart disease should be actively treated by a specialist.
(3) For patients with non-valvular atrial fibrillation, anticoagulation therapy with Warfarin is available when available, but coagulation indexes need to be tested, and anti-platelet aggregation drugs such as aspirin can also be taken orally.
(4) Patients with coronary heart should also take small doses of aspirin or other antiplatelet drugs.
8.How to recognize the recurrence of stroke and the corresponding measures to be taken
In case of sudden onset of limb weakness, slanting of the mouth and eyes, unfavorable speech or dizziness, shaky walking, nausea and vomiting, headache, etc., you should seek emergency treatment in the shortest possible time at a hospital with CT and MRI equipment and a neurologist or surgeon for fast and effective standardized treatment. Even if these symptoms improve or disappear within a short period of time, they should be seen in a hospital because they are likely to be transient cerebral ischemia (a manifestation of stroke), which, if ignored, can delay the best time for treatment and cause permanent cerebral infarction.