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| Guidelines recommend aggressive treatment after TIA or stroke |
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30 January 2006
A new set of guidelines recommends that survivors of stroke and transient ischaemic attack (TIA) both receive aggressive treatment to prevent a recurrent stroke. "Both conditions increase the risk of a subsequent stroke and both require similar diagnostic work-ups and treatment," lead author Dr Ralph L. Sacco from the Columbia University Medical Center in New York said. "Other documents have split the two conditions out, but we are treating TIA just as seriously as a stroke."
The guidelines, published by the American Heart Association and the American Stroke Association Council on Stroke in the February issue of Stroke, advise risk factor control for these patients that includes treatment with antihypertensives, even in the absence of a history of hypertension, as well as the standards of controlling blood lipid levels, obesity, hyperglycaemia, and obesity, and implementing smoking cessation.
The guidelines include interventional approaches for atherosclerotic disease, such as carotid endarterectomy and carotid artery balloon angioplasty and stenting. The recommendations also address antithrombotic treatments for cardioembolism, including patients with atrial fibrillation, acute MI and left ventricular thrombus, cardiomyopathy, and valvular heart disease. Antiplatelet agents are recommended for noncardioembolic ischemic stroke or TIA. The authors' discussion also includes recommendations regarding anticoagulation therapy in patients who have experienced a cerebral haemorrhage. The authors also specify treatments for stroke patients with other specific conditions, including arterial dissections, patent foramen ovale, hyperhomocysteinaemia, hypercoagulable states, sickle cell disease, and cerebral venous sinus thrombosis.
"Our intention is to have these statements updated every 3 years," the authors indicate, "with additional interval updates as needed, to reflect the changing state of knowledge on the approaches to prevention of a recurrent stroke.
Reference:
Stroke 2006; 37 (2):577-617.
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