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Progress in Clinical Neurosciences: Pharmacotherapies for the Secondar Prevention of Stroke

Published online by Cambridge University Press:  02 December 2014

Daniel G. Hackam  and
Moira K. Kapral
Daniel G. Hackam
Affiliation:
Division of Clinical Pharmacology, University of Toronto, Institute for Clinical Evaluative Sciences, Toronto and the Sunnybrook & Women's College Hospital, Toronto, Ontario, Canada
Moira K. Kapral
Affiliation:
Department of Medicine, University of Toronto, Institute for Clinical Evaluative Sciences, Toronto and the Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Ontario, Canada
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Abstract

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Stroke is a leading cause of mortality and long-term disability worldwide. Survivors of a previous stroke or transient ischemic attack are vulnerable to further cerebrovascular events, as well as myocardial infarction, peripheral vascular disease, congestive heart failure and vascular death. Traditional approaches to the secondary prevention of stroke have included aspirin after ischemic stroke, warfarin for stroke associated with cardioembolic sources, and carotid endarterectomy for eligible candidates with significant carotid artery stenosis. In recent years, much evidence has emerged to support a broader array of pharmacotherapies, including newer antiplatelet agents, lipid lowering drugs, and several classes of blood pressure lowering therapies. Also under study are B vitamins for patients with cerebrovascular disease and hyper-homocysteinemia, and oral direct thrombin inhibitors for high-risk patients with atrial fibrillation. We review the literature to determine the clinical significance of these therapies, and provide recommendations regarding their use in the prevention of recurrent stroke.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 3 , August 2004 , pp. 295 - 303
Copyright
Copyright © The Canadian Journal of Neurological 2004

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