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Stroke: prevent recurrences

After a stroke, there is a high risk of a recurrence or of a cardiovascular event. This risk can be averted through treatment with the usual cardiovascular prevention drugs or, in some cases, carotid surgery.

Prevention of ischaemic stroke relies mainly on antiplatelet drugs, most often aspirin, or in some cases other antiplatelet or oral anticoagulants. In the absence of antiplatelet treatment, the rate of stroke recurrence is around 6% per year, and a quarter of these are fatal. In 1000 patients, one year of antiplatelet treatment prevents 10 stroke recurrences, 2 to 3 myocardial infarctions and a total of around 6 deaths.

Other treatments are available, depending on the case. When blood pressure is over 140/80 mm Hg one or two weeks after the stroke, an antihypertensive treatment with a thiazide diuretic reduces the risk of a recurrence and of myocardial infarction.

In patients with high cholesterol, treatment with simvastatine prevents 6 coronary events for every 1000 patients treated each year.

In the case of the carotid artery being narrowed by more than 50%, carotid surgery can be offered, despite the immediate risk posed by the operation.

©Prescrire June 2005

Source: "Prendre en charge les accidents vasculaires cérébraux quatrième partie. Prévention après accident vasculaire cérébral ischémique : antithrombotique d'abord" Rev Prescrire 2005 ; 25 (262) : 436-442.

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