Stroke: What Measures to Prevent Recurrence?

Edward Jalil

After a first stroke, a number of precautions can reduce the risk of recurrence.

Preventing stroke recurrences: clotting inhibitors
Adopt a healthy lifestyle
Treating hypertension, the main risk factor for stroke
Stroke prevention: avoid thrombosis
Heart rhythm disorder and carotid artery stenosis: two specific risk factors
Prevention of recurrent stroke

Stroke is the second leading cause of death. The results appear alarming: half of the patients die in the medium term. Furthermore, the survivors will retain, for half of them (25% of the total), very disabling physical or intellectual after - effects . The remaining quarter will generally have less significant after-effects but which are not without repercussions. Among these, there is a high proportion of nervous breakdowns.

The occurrence of a stroke reflects the presence of predisposing factors , which it is important to correct to improve the prognosis . In the absence of preventive measures, the risk of recurrence is around 10% at 5 years.

Preventing stroke recurrences: clotting inhibitors
After the occurrence of a first stroke, the most widely recognized preventive treatment is based on the taking of blood clotting inhibiting drugs : anti-platelet agents .

The products concerned include in particular low-dose aspirin, ticlopidine and clopidrogrel . These drugs have improved the prognosis but are not a true panacea.

Indeed, a stroke can be due either to the blockage of a vessel (in about 85% of cases) or to a cerebral hemorrhage (in 15% of cases). Anti-platelet agents are unfortunately only effective in the first case and are contraindicated in the other ...

Adopt a healthy lifestyle
After a stroke, everything must be done to adopt a healthy lifestyle to minimize the risk of recurrence. The main steps to take are:

The establishment of a balanced diet ;
The practice of regular physical activity ;
Quitting tobacco and alcohol consumption ;
The stress management (if needed, do not hesitate to consult a psychologist because the consequences of stroke can be challenging).
It is also essential to monitor diabetes as well as the cholesterol and triglyceride levels in the blood.

Treating hypertension, the main risk factor for stroke
High blood pressure is the main risk factor for stroke, it is involved in 40% of strokes. Taking it into account will reduce the risk of recurrence. If the beneficial effects of anti-hypertensive treatment primarily concern cerebral hemorrhages , they also extend to ischemic attacks (lack of oxygenation of the brain) and could even concern people with normal blood pressure.

The results of a large international study were presented by Marie Germaine Bousser the 17 th World Congress of Neurology June 22, 2001, in London. Over 6,000 stroke patients participated in the study, whether or not they were hypertensive. An anti-hypertensive treatment ( by ACE inhibitor ) and diuretic resulted in a reduction in recurrence of 40% , compared to placebo. It also reduced the risk of death and slowed down the decline in brain function often associated with a lack of brain oxygenation.

The treatment should be instituted in the days following the stroke . More studies are needed to clarify its place in people with normal blood pressure.

Stroke prevention: avoid thrombosis
Ischemic attacks, four times more frequent than hemorrhages in the brain, are linked to the obstruction of the arteries of the brain by a blood clot (thrombosis). They generally occur on arteries already narrowed by atherosclerotic plaques . These yellowish plaques consist of deposits of fat on the internal surface of the artery.

The anti-platelet agents , such as low-dose aspirin, prevent the formation of these thrombi and are prescribed after a first accident to prevent recurrences. Treatments that lower blood cholesterol levels , such as statins , also seem to work.

Again, complete cessation of smoking and alcohol is essential and oral contraception is definitely contraindicated.

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