The Society of Neurology of the Chinese Medical Association (CMA) has launched the “2010 Guidelines for Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack (TIA) in China”. Professor Zeng Jinsheng, President of the Neurology Branch of the Guangdong Medical Association and Director of the Department of Neurology at the First Hospital of Sun Yat-sen University, emphasized that the key to secondary prevention of ischemic stroke lies in the early etiological diagnosis of stroke patients, the use of evidence-based medical evidence, a comprehensive risk assessment of patients, and stratification of patients according to the number and severity of risk factors, leading to early individualized treatment.
It is reported that there are about 7 million patients with cerebrovascular disease in China, of which 70% are ischemic stroke patients. A significant proportion of these patients are accompanied by multiple risk factors such as hypertension and diabetes mellitus, and as a result, the recurrence rate of stroke has increased significantly. Although measures such as smoking cessation, blood pressure lowering and antithrombotic drugs are known to be effective in reducing stroke recurrence, lack of awareness of health education among clinicians and poor compliance of patients have led to inappropriate or insufficient application of recurrence prevention measures for stroke patients after discharge from hospital. Hu Jun, Department of Neurology, Peking University Shenzhen Hospital
Prof. Zeng Jinsheng introduced that the Guidelines include five major parts: risk factor control, non-pharmacological treatment of patients with large atherosclerosis, antithrombotic treatment of cardiogenic embolism, antithrombotic treatment of non-cardiogenic ischemic stroke/TIA, and treatment of stroke patients in other special circumstances. One of the core components is risk stratification, which means that patients are classified into very high risk, high risk, and low risk classes according to factors such as patient age and underlying disease, using the ESSEN stroke risk score or the ABCD2 scale, and then individualized secondary prevention. For example, for patients at high risk of stroke (those with an ESSEN score of 3), long-term antiplatelet drugs should be given.
In addition, the Guidelines emphasize that secondary prevention should be started in patients with ischemic stroke and TIA from the acute phase. According to the EXPRESS study, patients given urgent evaluation and intervention within 1 day of acute ischemic stroke onset had an 80% lower risk of total recurrence of stroke at 90 days compared with delayed-treatment patients (evaluation given an average of 3 days after onset and prescribed treatment given at 20 days).
From Health News