recurrent stroke affects about 9%-15% of the population of
within one year. This article mainly provides guidance and suggestions for long-term secondary prevention drug intervention after ischemic stroke or transient cerebral ischemic attack , involving the management of blood, blood sugar, blood lipids and antiplatelet therapy.
Yimaitong compiled and compiled, please do not reprint without authorization.
Question 1: For patients with a previous history of ischemic stroke or TIA, can antihypertensive therapy be used better than not antihypertensive therapy?
Evidence-based recommendation: For patients with previous history of ischemic stroke or TIA, antihypertensive therapy is recommended to reduce the risk of stroke recurrence. (Quality of evidence: high, recommendation intensity: strong)
Question 2: When patients with previous history of ischemic stroke or TIA start treatment, can the use of outdoor blood pressure measurements in the clinic better control blood pressure for a long time compared with blood pressure measurements in the clinic?
Expert consensus statement: For patients with previous history of ischemic stroke or TIA, it is supported to use outdoor blood pressure measurements when feasible to achieve better long-term blood pressure control.
Question 3: For patients with a previous history of ischemic stroke or TIA, will higher intensity (i.e., blood pressure 130/80mmHg) reduce the risk of relapse stroke better than the treatment goal of lower intensity (140/90mmHg) when starting or intensively lower hypotensive treatment?
Evidence-based recommendation: For patients with previous history of ischemic stroke or TIA, it is recommended to set the blood pressure target at 130/80 mmHg to reduce the risk of relapsed stroke. (Quality of evidence: Moderate, Recommendation: Weak)
Question 4: For patients with previous history of ischemic stroke or TIA, do the two antihypertensive drugs reduce the risk of stroke recurrence than a single antihypertensive drug?
Expert consensus statement: For patients with previous history of ischemic stroke or TIA, the use of two antihypertensive drugs is supported to reduce the risk of stroke recurrence, and consider the potential risk of hypotensive , such as weak, elderly and critical hypertensive patients.
Question 5: For patients with previous ischemic stroke or TIA, can HMGCoA reductase inhibitors be more likely to reduce the risk of stroke recurrence than without lipid-lowering therapy?
Evidence-based recommendation: For patients with previous ischemic stroke or TIA, HMGCoA reductase inhibitors are recommended to reduce the risk of ischemic stroke recurrence. (Quality of evidence: high, recommendation strength: strong)
Question 6: In patients with ischemic stroke or TIA, can intensive cholesterol treatment targets be more likely to reduce the risk of stroke recurrence compared with non-intensive goals?
Evidence-based recommendation: For patients with ischemic stroke or TIA, it is recommended to control the low-density lipoprotein cholesterol (LDL-C) level at 1.8mmol/L (70mg/dL) to reduce the risk of major cardiovascular events. (Quantity of evidence: Moderate, Recommendation: Strong)
Question 7: In patients with previous ischemic stroke or TIA, despite taking the maximum tolerated dose of HMGCoA reductase inhibitor for at least 6 weeks, the recommended LDL-C target is not met. Is the addition of erzemebu and/or PCSK9-inhibitor better than using HMGCoA reductase inhibitor alone to reduce the risk of stroke recurrence?
Expert consensus statement: In patients with ischemic stroke or TIA, although the maximum tolerated dose of HMGCoA reductase inhibitor was taken at least 6 weeks, the recommended LDL-C target was not met, and the addition of ezemeb as an option to reduce the risk of recurrence of major cardiovascular events.
Question 8: In patients with ischemic stroke or TIA, can long-term antiplatelet therapy reduce the risk of stroke recurrence better than non-platelet therapy?
Evidence-based recommendation: For patients with previous history of ischemic stroke or TIA, long-term antiplatelet therapy is recommended to reduce the risk of stroke recurrence. (Quantity of evidence: moderate, recommendation strength: strong)
Question 9: In patients with TIA and ischemic stroke, does double antiplatelet therapy with aspirin combined with clopidogrel or aspirin combined with dipyridamole more than 90 days reduce the risk of stroke recurrence compared with single antiplatelet therapy?
Evidence-based recommendation: For patients with previous history of ischemic stroke or TIA, it is not recommended to use double antiplatelet therapy with aspirin combined with clopidogrel for a long time, and it is recommended to use single antiplatelet therapy to reduce the risk of stroke recurrence. (Quantity of evidence: Very low, recommendation strength: weak)
Question 10: In patients with ischemic stroke or TIA and atherosclerosis without indications for anticoagulation, does antiplatelet therapy combined with low dose direct oral anticoagulant medications better reduce the risk of stroke recurrence than antiplatelet therapy alone?
Expert consensus statement: For patients with previous ischemic stroke or TIA history for more than 1 month, antiplatelet therapy combined with low-dose direct oral anticoagulant drugs (rivaroxaban) can be considered to optimize the treatment of coronary artery disease or peripheral artery disease. Combination is not considered for patients with ischemic stroke or TIA without coronary artery disease or peripheral artery disease.
Question 11: In patients with embolizing stroke (ESUS) of unknown origin, can direct oral anticoagulant treatment better reduce the risk of stroke recurrence compared with antiplatelet therapy?
Evidence-based recommendation: For patients with embolizing stroke of unknown origin, antiplatelet therapy is recommended instead of direct oral anticoagulant therapy to reduce the risk of relapsed stroke. (Quality of evidence: low, recommendation strength: weak)
Question 12: In diabetic and ischemic stroke or TIA patients, is the enhanced control of glycated hemoglobin level (HbA1c) can reduce the risk of stroke recurrence than low intensity control of HbA1c?
Expert consensus statement: For patients with ischemic stroke or TIA and diabetes, HbA1c level is supported to control at 53 mmol/mol (7%, 154 mg/dL) to reduce the risk of microvascular and macrovascular complications. However, this goal may need to be individualized based on the course, age and comorbidities of diabetes.
Question 13: In patients with ischemic stroke or TIA, is pioglitazone more likely to reduce the risk of stroke recurrence than without pioglitazone?
Evidence-based recommendation: For patients with ischemic stroke or TIA with insulin resistance or 2 diabetes , pioglitazone is recommended to reduce the risk of stroke recurrence. (Quality of evidence: medium, recommendation strength: weak)
Yimaitong compiled from: European Stroke Organisation (ESO) guideline on pharmaceutical interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack
