national-clinical-guidelines-for-stroke-fourth-edition

5 Secondary prevention
5.0 Introduction
This chapter covers secondary prevention. From the moment a person has an acute
cerebrovascular event (of any sort), they are at increased risk of further events. The risk is
substantial, 26% within 5 years of a first stroke and 39% by 10 years (Mohan et al 2011);
there are additional risks of about the same magnitude for other vascular events (eg
myocardial infarction). There are a few exceptions, for example patients who have a
stroke secondary to arterial dissection.
The risk of further stroke is highest early after stroke or TIA and may be as high as 5%
within the first week and 20% within the first month. Appropriate secondary prevention
should therefore be commenced as soon as possible, usually in the acute phase provided
it is safe to do so. However, it is also vital that attention to secondary prevention should
be continued throughout the recovery and rehabilitation phase and for the rest of the
person’s life.
Some of the recommendations in the acute phase, such as starting aspirin
immediately after ischaemic stroke, are part of secondary prevention. This chapter
assumes that all the recommendations made in chapter 4 have been implemented.
The recommendations concerning the early reduction of risk are not repeated here,
but it is essential that immediate treatments are carried out as part of secondary
prevention.
5.1 Identifying risk factors
The risk of recurrent vascular events may vary significantly between individuals
according to underlying pathology, comorbidities and lifestyle factors. This guideline
applies to the vast majority of patients with TIA and stroke, including those not admitted
to hospital, although some of the recommendations may not be appropriate for the small
minority of patients with unusual stroke pathologies.
5.1.1 Recommendations
A Every patient who has had a stroke or TIA and in whom secondary preventation is
appropriate should be investigated for risk factors as soon as possible and certainly
within 1 week of onset.
B For patients who have had an ischaemic stroke or TIA, the following risk factors
should also be checked for:
● atrial fibrillation and other arrhythmias
● carotid artery stenosis (only for people likely to benefit from surgery)
● structural and functional cardiac disease.
© Royal College of Physicians 2012 61