Prevention of Recurring Strokes
- Decreasing Hypertension: Aggressive lifestyle changes and/or medication will be used to keep blood pressure under control. Typically, the goal is to lower your systolic blood pressure another 10 points and your diastolic blood pressure another 5 points (for a review of these terms, please click here). So, if your blood pressure was 140/80 prior to your stroke, the goal would be to lower your blood pressure to 130/75.
- Controlling Risk Factors: Your doctor will monitor and treat risk factors including high cholesterol, obesity, diabetes, smoking, and lack of exercise all in an effort to decrease the risk of having another stroke.
Medications:Warfarin(Coumadin): Warfarin is an anticoagulant medication used to treat persistent atrial fibrillation (erratic heart beats and blood flow patterns) by thinning the blood to prevent the formation of clots. It has been shown to decrease the chance of recurrent stroke by about 2/3 in patients with atrial fibrillation. Primarily, Warfarin is used to prevent stroke in patients with atrial fibrillation who have a high risk of a second stroke (i.e., people who are older than 75 years, and have diabetes, heart disease, and prior history of stroke/TIA). Warfarin is also used with individuals who are hypercoaguable (genetically more likely to form blood clots). People who take Warfarin must undergo close monitoring of blood levels and their diet. Also, patients need to be cautious about taking additional medications, since many drugs interact with Warfarin and can affect the level of thinning of the blood. There is also an increased chance of internal bleeding while taking this medication.
Aspirin: Taking aspirin following a stroke or TIA decreases the chance of a second stroke by about 25%. Aspirin is also used to prevent stroke in patients with atrial fibrillation and hypercoaguable states. A typical recommended dose of aspirin is 325 mg. Any decision about whether to use aspirin and the specific dose best for you should be discussed with your doctor.
Aspirin should not be used if your blood pressure is not well-controlled. In addition, a concerning (yet low frequency) potential side-effect of aspirin is gastrointestinal bleeding. The risk of this type of bleeding is greater if higher doses of aspirin are taken.
Ticlopidine: Ticlopidine (Ticlid) is another anticoagulant that is very effective in decreasing the chance of another stroke in a person with a history of stroke or TIA. However, given its expense, increased side effects (e.g., possible lowering of the white blood cell counts, which can cause infection, bruising, and bleeding) and the need to tightly monitor blood counts when it is first started, physicians usually reserve ticlopidine for patients who fail aspirin therapy (i.e. have another stroke despite treatment with aspirin)
Dipyridamole: Dipyridamole (Persantine) also falls in the group of anticoagulant medications that stops blood from clotting. Some studies suggest that a combination of aspirin and dipyridamole maybe more effective than aspirin alone. However, this combination is more expensive than aspirin alone and may cause headache. The effectiveness of using this combination to prevent future stroke continues to be studied.
- Carotid Endarterectomy: If you have had a stroke or TIA and there is blockage in the carotid arteries of your neck, your doctor may recommend an endarterectomy to improve blood flow and decrease the chance that plaques will break off and cause a blockage. During this procedure, a doctor surgically removes the blockage. Carotid endarterectomy is most successful in preventing strokes in patients with a prior history of stroke or TIA who have greater than 70% blockage of their carotid arteries.