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New Stroke Prevention Guidelines from the Stroke Council of the American Heart Association

Susan C. Fagan, Pharm.D., BCPS, FCCP
June, 2006

Article: Sacco RL, Adams R, Albers G, et. al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006 Feb;37(2):577-617.

The long-awaited update of the Stroke Council's 1999 secondary stroke prevention guidelines¹ were published in February of 2006. In contrast to the predecessor, the new guidelines are much more comprehensive, are evidence-based and each recommendation is given a grade for the strength of the supporting evidence. In the new guidelines, it is recommended that TIA and stroke be treated with equal urgency and aggressiveness and an approach that lessens the risk of ALL vascular events (not just ischemic stroke) is recommended. There are no big surprises in the guidelines and they are consistent with other published guidelines dealing with vascular risk reduction. Risk factor control, including hypertension, diabetes and lipids are included as well as recommendations regarding physical activity, smoking cessation and alcohol. In addition, specific pharmacologic and surgical interventions are recommended for patients with specific etiologic conditions. The strongest recommendations (level A) are made for:

1. Antihypertensive treatment
2. Diabetes control
3. Statin therapy
4. Carotid endarterectomy for large artery atherosclerosis
5. Warfarin for atrial fibrillation
6. Antiplatelet therapy for noncardioembolic stroke or TIA

Reference

1. Wolf PA, Clagett GP, Easton JD, et al. Preventing ischemic stroke in patients with prior stroke and transient ischemic attack : a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke. 1999 Sep;30(9):1991-4.

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