Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

TLDR

This updated guideline offers evidence‑based recommendations for preventing recurrent stroke in survivors of ischemic stroke or TIA, targeting clinicians who manage secondary prevention. The guideline provides evidence‑based recommendations for risk‑factor control, vascular obstruction intervention, antithrombotic therapy for cardioembolism and non‑cardioembolic stroke, and specific conditions such as aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid syndrome, sickle cell disease, cerebral venous sinus thrombosis, pregnancy, and post‑intracranial hemorrhage antithrombotic use, along with implementation guidance.

Abstract

The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.