Secondary Prevention of Stroke
A large study of stroke prevention was conducted in Europe
Patients in the aspirin group were given aspirin 25 mg/dose twice a day;
Patients in the pansentine group were given extended-release pansentine 200 mg/dose twice a day
Patients in the combination M were given 25 mg/dose of aspirin + 200 mg/dose of extended-release pansentine twice a day and were compared with the placebo group.
The results showed that.
The aspirin/slow-release pansentine combination was more significant than the monotherapy in preventing recurrent stroke.
Compared with the control group, the rate of secondary strokes.
18% decrease in the aspirin group;
16% in the pansentine group;
In the combination group, there was a 37% decrease.
Anticoagulation
Not advocated for widespread use due to bleeding side effects and high laboratory requirements
Use to prevent cerebral embolism is well established in certain cardiac diseases (rheumatic heart disease) because of the persistent embolic mechanism.
Anticoagulation
Identify the mechanism of stroke occurrence
Appropriate use of anticoagulants such as warfarin
Recommended INR: 2.0-3.0 safe and effective
Identify atrial fibrillation induced cardiogenic embolism
Aspirin plus anticoagulant
Anticoagulant therapy
Urokinase plus anticoagulant: AUST study
Transarterial injection of urokinase via angiography in addition to oral anticoagulants reduces stroke recurrence and mortality more than oral anticoagulants alone
Interventions for other heart diseases
Treat the primary disease for its cause
Myocardial infarction: maintenance of cardiac output: beta-blockers, ACEI, appropriate anticoagulants or antiplatelet agents
Infective endocarditis: antibiotics
Surgical intervention for carotid artery stenosis
Looking for evidence of carotid stenosis
Carotid ultrasound, MRA, TCD, DSA
Intervention according to the degree of stenosis
Mild stenosis (≤29%): conservative medical treatment
Moderate stenosis (30%-69%): not sure
Surgical intervention for carotid stenosis
Severe stenosis (70%-99%): surgery
Carotid endarterectomy can be performed repeatedly
Other surgical procedures
Carotid angioplasty
Placement of carotid artery stents
Intervention for homocysteinemia
Homocysteinemia
Plasma cysteine level above 16umol/l
Interventions
Folic acid 2mg, VitB12500ug, VitB625mg
VISP and VITATOPS study
Intervention TIA
Patients with TIA are at risk of secondary stroke
Interventions
Removal of risk factors
Timely application of anticoagulation therapy
Administration of antiplatelet agents
Interventions for post-stroke cognitive impairment
Mostly after acute ischemic cerebrovascular disease
Risk factors for cognitive impairment
Advanced age, low education level, history of multiple cerebrovascular accidents, excessive
Smoking, low arterial blood pressure, etc.
Differentiation of post-stroke dementia from other related disorders
Interventions
Stabilization of blood pressure, neuroprotective agents, improvement of brain function and memory, etc.
Pharmacological interventions
Intervention for post-stroke cognitive impairment
Aphasia intervention
PASS II study
Piracetam 12g/d×4weeks
4.8g/d×3 months
Intervention for post-stroke depression
Incidence: 40%-50%
High risk period: Initial 2 years after stroke
Associated factors
Older age at onset, high family burden, more infarct foci, lack of
social contact, personality traits
Interventions
Drug therapy, psychotherapy, electroconvulsive therapy, etc.
Management of lipids after stroke
Increased risk of recurrence with plasma cholesterol >240 mg/dl
Active monitoring of lipid levels
Dietary control, physical exercise, pharmacological intervention (statins)
SPARCL study
Evaluate the protective effect of statin 80mg/d (ongoing study no results yet)
Management of post-stroke glucose
Although diabetes is considered an independent risk factor for ischemic stroke, it has not been established whether strict glycemic control reduces the incidence of stroke.
In type 2 diabetes, sulfonylurea and/or insulin therapy may improve microvascular complications but not macrovascular complications, such as stroke.
Management of post-stroke glucose
Monitoring of blood glucose levels is controversial
Diabetes mellitus as an uncertain risk factor
Increased risk of recurrence with blood glucose >140 mg/dl
GIST program
Infusion of polarizing fluid to maintain normoglycemia
Glycosylated hemoglobin (HBAIc) not associated with stroke recurrence
Risk factor interventions
Smoking
Risk of stroke reduced by 50 complete abstinence from smoking after quitting smoking, %.
Alcohol consumption
Limit the amount of alcohol consumed
Obesity
WHR as a precise defining indicator
Reasonable diet, physical activity
Risk factor interventions
Different interventions for different age, gender and ethnic groups
Health education
Change sedentary lifestyle
Regular physical exercise
Regular checkups and reasonable exercise programs for high-risk patients
Rehabilitation of stroke patients
Develop a rehabilitation plan
Set rehabilitation goals
Begin rehabilitation after the patient’s vital signs have stabilized
Acute phase: prevention of disability
Recovery phase: comprehensive rehabilitation (Bobath method, Brunnstrom
method, weight reduction bicycle method, functional electrical stimulation, biofeedback therapy)