In 2021, the American Heart Association and American Stroke Association issued a joint document titled Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. The guideline provides medical personnel with evidence-based recommendations to help their patients avoid a second stroke.
Recommendations for stroke risk reduction
Since each patient is different and the type of stroke can vary, it is critical to customize treatment for each patient’s particular needs. The following are the main points the guideline covers:
The AMA/ASA provides recommendations for a diagnostic workup after a stroke in order to define the ischemic stroke etiology and develop a targeted post-stroke plan to reduce the risk of a recurring stroke event.
Vascular risk factors are a key concern post-stroke. Issues such as diabetes, smoking, lipids, and hypertension should be managed and reduced or eliminated, utilizing a team of experts whenever possible.
Where lifestyle choices contribute to stroke risk, these factors must be addressed. To decrease stroke risk, patients should be encouraged to lower salt intake and switch to a Mediterranean-style diet, which emphasizes healthy oils such as extra-virgin olive oil, more fish and less fatty red meat, moderate consumption of red wine, and limited sweets and bakery products. Sedentary behavior should be discouraged, with supervised physical activity encouraged.
Physicians should go beyond simply recommending these lifestyle changes, but rather should incorporate proven techniques and multidisciplinary team members into the stroke risk-reduction plan.
Antithrombotic therapy is recommended for almost all stroke patients without contraindications. This includes antiplatelet or anticoagulant agents. Guidance is provided regarding dual antiplatelet therapy, which is not recommended for the long term.
Atrial fibrillation is a high-risk condition for second ischemic stroke. Anticoagulation treatment and/or heart rhythm monitoring can provide help in lowering stroke risk.
Extracranial carotid artery disease can be a stroke factor; thus patients with severe stenosis ipsilateral to a non-disabling stroke or TIA who are candidates should have the stenosis fixed. However, patients with severe intracranial stenosis in the vascular territory of ischemic stroke or TIA should not receive angioplasty or stenting, if possible. Other medical treatments should be attempted.
Due to recent research and clinical experience, it is now considered reasonable to percutaneously close patent foramen ovale in patients who: are 18-60 years old, have a nonlacunar stroke, have no other identified cause of the stroke, and have high-risk patent foramen ovale features.
It has been found that treatment of embolic stroke of uncertain source with anticoagulant or ticagrelor shows no benefit, and therefore should not be followed.
Medical professionals should familiarize themselves with the details of this important guideline. Nearly 25% of all strokes are in patients who have had strokes before, so helping to reduce the risk of another stroke is critical to the long-term health of the patient. At Neuralert, we are committed to decreasing the pain and suffering associated with stroke. The Neuralert Stroke Detection System incorporates state-of-the-art AI technology with a lightweight, non-invasive wristband that can signal medical professionals when a common sign of stroke – asymmetrical arm movement – first appears. The algorithm mathematically models out known factors of asymmetry, such as hand dominance, eating, etc., virtually eliminating false alarms.
Let Neuralert partner with your healthcare facility to give your stroke patients the best chance at avoiding a second, debilitating stroke.