Magazine article Drug Topics

Comprehensive Guidelines on Preventing First Stroke Released

Magazine article Drug Topics

Comprehensive Guidelines on Preventing First Stroke Released

Article excerpt

Most of us are at least aware of the existence of various stroke-prevention recommendations for individuals who have already suffered a stroke and are at risk for another one. But how do we go about avoiding the first stroke? Certainly, medical opinions on the matter are not lacking, but, until now, a consensus document encompassing the recommendations of leading stroke experts did not exist.

The National Stroke Association (NSA) has now released the first national set of guidelines on action steps medical professionals can take in patient management to help prevent stroke. The document was published in the March 24 edition of the Journal of the American Medical Association. "For the first time, we have been able to give [health professionals] a standardized way to manage patients and their risk for stroke," declared Philip Gorelick, M.D., professor and director of the Center for Stroke Research, Rush-PresbyterianSt. Luke's Medical Center, and chair of the NSA Stroke Prevention Advisory Board.

Identifying risk factors for stroke is relatively simple; the offending lifestyle factors and conditions are clearly stated at the beginning of the document and include:

hypertension

myocardial infarction (MI)

atrial fibrillation (AF)

diabetes mellitus (DM)

blood lipids

asymptomatic carotid artery disease

smoking and alcohol use

Minimizing some of these risk factors from a pharmacologic standpoint is the complicated part. For those with AF, warfarin appears to be the drug of choice since it has been shown to reduce stroke occurrence by 68% in studies evaluating individuals with this cardiovascular condition. According to Gorelick, the recommendations for antithrombotic therapy in patients with AF have been stratified.

All AF patients who are 75 years of age and older, with or without risk factors, should receive warfarin; those who are less than 75 years of age and have a risk factor such as hypertension or cardiac disease should also be placed on warfarin. AF patients who are aged 65 to 75 and have no risk factors may be considered for either warfarin or aspirin (ASA), and those with AF who are less than 65 with no risk factors should be placed on ASA.

In patients who have suffered an MI, the stroke guidelines recommend using warfarin if those particular individuals have certain concomitant cardiovascular conditions, such as decreased left ventricular function or persistent AF, and those who have had left ventricular thrombi detected within several months of MI. An INR range of 2.0 to 3.0 with a target goal of 2. …

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