What do the AHA/ASA guidelines emphasize for secondary prevention of stroke?

Updated: May 27, 2020
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Guidelines issued in 2014 by the American Heart Association (AHA)/American Stroke Association (ASA) on the secondary prevention of stroke emphasize nutrition and lifestyle and include a new section on aortic atherosclerosis. New recommendations include the following: [131, 132]

  • Patients who have had a stroke or transient ischemic attack (TIA) should be screened for diabetes and obesity

  • Patients should possibly be screened for sleep apnea

  • Patients should possibly undergo a nutritional assessment and be advised to follow a Mediterranean-type diet

  • Patients who have had a stroke of unknown cause should undergo long-term monitoring for atrial fibrillation (AF)

  • The new oral anticoagulants dabigatran (class I, level of evidence [LOE] A), apixaban (class I, LOE B), and rivaroxaban (class IIa, LOE B) are among the drugs recommended for patients with nonvalvular AF

Based on research results, the guidelines also recommend that, in patients without deep venous thrombosis (DVT), a patent foramen ovale not be closed. In addition, because there is little data to suggest that niacin or fibrate drugs, as a means to raise high-density lipoprotein (HDL) cholesterol, reduce secondary stroke risk, the guidelines no longer recommend their use.

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