AHA/ASA Publish Updated Stroke Prevention Guidelines

October 21, 2010—The American Heart Association/American Stroke Association announced the publication of revised stroke prevention guidelines online ahead of print in Stroke. The guidelines were last updated in 2006. In the United States, 795,000 strokes occur annually. Of these, approximately 87% are ischemic strokes, and approximately 25% occur in patients who have had a previous stroke.

The guidelines writing committee chair, Karen Furie, MD, commented, “Since the last update, we've had results from several studies testing different interventions. We need to re-evaluate the science every few years to optimize prevention.”

According to the guidelines, treating metabolic syndrome and undergoing carotid angioplasty may prevent recurrent stroke or transient ischemic attack (TIA). Key updates include:

• The value of screening for metabolic syndrome after stroke is still not clear; however, if it is diagnosed, patients should receive counseling for lifestyle changes and treatments for metabolic syndrome components that are also stroke risk factors, especially high blood pressure and high cholesterol.
• If a stroke survivor has severe blockage of the carotid artery, angioplasty and stenting may be an alternative to surgery if the patient is at low risk for complications.
• Excluding patients whose stroke or TIA was caused by a clot from the heart, among those taking an antiplatelet drug to prevent another stroke, either aspirin alone, aspirin combined with dipyridamole, or clopidogrel are reasonable options. Therefore, patients and doctors must consider risk factors, cost, tolerance, and other characteristics to tailor the appropriate therapy.
• Stroke or TIA survivors who are diabetic should follow existing guidelines for blood sugar control.
• All stroke or TIA patients who have a carotid artery blockage should aim for optimal medical therapy through a multifaceted approach, including antiplatelet drugs, statin therapy, and lifestyle risk factor changes such as blood pressure management.
• When patients with high stroke risk due to atrial fibrillation need to temporarily stop taking warfarin, they should receive low-molecular-weight heparin as bridging therapy to reduce the risk of blood clots.

Dr. Furie added that high blood pressure is the most critical risk factor for recurrent stroke. Doctors should work with patients to find the best drug regimen to suit each individual's blood pressure control needs.