[Prevention of vascular events after transient ischemic attack or cerebral infarct].
After a first cerebral ischemic event, secondary prevention should be started as soon as possible, especially in transient ischemic attacks where the risk of recurrence is the highest, especially during the first week, needing a diagnostic workup in a short period of time, secondary prevention measures depending on the presumed cause of the event. Secondary prevention of vascular events after transient ischemic attack or cerebral infarct consists of 3 types of strategies: 1. treatment of risk factors for stroke, especially high blood pressure, high cholesterol and smoking cessation; 2. aspirin (50 to 325 mg), or clopidogrel, or association aspirine-dipyridamole in high-risk subjects, or warfarin in patients with high-risk cardiopathies; and 3. carotid surgery in patients selected by clinical and imaging criteria. Other strategies are currently partly under evaluation: statins in normocholesterolemic ischemic stroke patients without coronary event, angioplasty with stenting. Audits of practice are necessary to determine whether patients are actually treated according to scientific evidence. This is a crucial issue if we want the results of trials to be translated in the true life, and really improve health at the community level.
Leys
Didier
D
Equipe d'accueil EA 2691, Université Lille II), service de neurologie et pathologie neurovasculaire, hôpital Roger-Salengro, 59037 Lille. dleys@chru-lille.fr
Cordonnier
Charlotte
C
D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D002544:Cerebral Infarction / Q000188:drug therapy / Q000628:therapy*; D000077144:Clopidogrel; D004176:Dipyridamole / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002546:Ischemic Attack, Transient / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
D000925:Anticoagulants; D000960:Hypolipidemic Agents; D010726:Phosphodiesterase Inhibitors; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin