Medical Management for Secondary Stroke Prevention.
Review published in Continuum (Minneapolis, Minn.) (2020)
Abstract
PURPOSE OF REVIEW: This article reviews the evidence base and recommendations for medical management for secondary stroke prevention. RECENT FINDINGS: Recent developments for secondary stroke prevention include evidence to support the use of short-term dual antiplatelet therapy after minor stroke and transient ischemic attack, direct oral anticoagulants for nonvalvular atrial fibrillation, reversal agents for direct oral anticoagulant-associated hemorrhage, and aspirin rather than presumptive anticoagulation with a direct oral anticoagulant for embolic stroke of undetermined source. SUMMARY: Most strokes are preventable. The mainstays of medical management for secondary stroke prevention include antihypertensive therapy; antithrombotic therapy, with antiplatelet agents for most stroke subtypes or anticoagulants such as warfarin or a direct oral anticoagulant for cardioembolic stroke specifically; cholesterol-lowering therapy, principally with statins, but with potential roles for ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors in selected patients; and glycemic control to prevent microvascular complications from diabetes mellitus or pioglitazone in selected patients with insulin resistance but not diabetes mellitus.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
This article reviews the evidence base and recommendations for medical management for secondary stroke prevention. Recent developments for secondary stroke prevention include evidence to support the use of short-term dual antiplatelet therapy after minor stroke and transient ischemic attack, direct oral anticoagulants for nonvalvular atrial fibrillation, reversal agents for direct oral anticoagulant-associated hemorrhage, and aspirin rather than presumptive anticoagulation...
Why This Matters for Hirudotherapy
This review summarizes current medical management for secondary stroke prevention, covering antihypertensive, antithrombotic (antiplatelet or anticoagulant), cholesterol-lowering, and glycemic strategies, and notes recent evidence supporting short-term dual antiplatelet therapy after minor stroke/TIA, direct oral anticoagulants for nonvalvular atrial fibrillation, and reversal agents for direct-oral-anticoagulant-associated hemorrhage. For ASH it provides clinical context for where anticoagulation fits in cerebrovascular care and the bleeding-reversal concerns that accompany it, which frame the safety considerations for any antithrombotic derived from the leech secretome (such as direct thrombin inhibitors structurally related to hirudin). This is a narrative review consolidating others' findings and guidelines rather than primary data, and it neither studies nor mentions hirudotherapy; it informs the anticoagulant-safety backdrop, not leech-therapy efficacy.
Citation
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