Proper assessment of the pathogenesis of first cerebral infarction
1.Arteriosclerotic thrombotic infarction
2.Cardiogenic embolism
3.Lacunar infarction-small vessel disease
4.Understood cause
Recommendation.
Select the necessary imaging or other laboratory tests for patients who have had a stroke to clarify the type of stroke and associated risk factors as much as possible so that reasonable therapeutic measures can be applied to the cause.
Proper assessment of the cause of hemorrhagic stroke
1. hypertensive cerebral hemorrhage
2.Intracranial aneurysm
3.Intracranial vascular malformation
4.Other
Post-stroke blood pressure management
Suggestions.
1.Change the bad life style
2.Control the blood pressure by using 2 or more drugs to lower the blood pressure to <140/90mmHg as slowly as possible.
3. Antihypertensive therapy should be started when the acute phase of stroke is over and the disease is stable (usually 2-4 weeks after stroke). The dose of aspirin alone for intervention of platelet aggregation is 50-150 mg/day; combination: a combination of low-dose aspirin (25 mg) and pansentine extended-release (200 mg) twice daily. Clopidogrel, 75 mg/day, was chosen for those with the condition, those at high risk, or those intolerant to aspirin.
Study results
507 centers in 28 countries worldwide participated
A total of 7599 cases were enrolled
Patients with recent TIA or ischemic stroke treated with clopidogrel plus aspirin for 18 months
Results: No significant benefit was seen in the clopidogrel+aspirin group
and there was an increased risk of bleeding
Anticoagulation
Anticoagulation is not recommended in the acute phase of stroke and can usually be started after 2 weeks;
Non-valvular atrial fibrillation can be treated with warfarin (2-4 mg/day) and should be limited to hospitals with available INR monitoring.
Note: INR values should be controlled between 2.0 and 3.0.
Intervention TIA
Active search for the cause and control of related risk factors
Treatment with antiplatelet aggregation drugs, aspirin, clopidogrel, or low-dose aspirin + pansentine extended-release
Anticoagulation if necessary
Do not recommend reserpine; if used, monitor blood cells
Management of lipids and blood glucose after stroke
It has been suggested that the risk of stroke recurrence increases with serum total cholesterol levels >240 mg/dl (6.24 mmol/L) and the risk of stroke recurrence increases with fasting glucose levels.
Treatment and recommendations for hyperlipidemia and hyperglycemia
1. Statin lipid-lowering drugs
2.Early sedation of GIK solution (glucose-potassium chloride-insulin)
3.Regular monitoring of blood glucose and lipid is recommended
4.Diet monitoring, increase exercise
5.Medication if necessary