22B. Secondary prevention of stroke

Antiplatelet therapy

Should be initiated in all patients after ischaemic stroke. Either aspirin or a P2Y antagonist. Treatment should be initiated as soon as possible of ischaemic stroke onset, except if the patient receives thrombolysis, in which case it should be started 24 hours after.

Cholesterol management

Should be initiated in all patients after ischaemic stroke. Statins are beneficial for all patients, even if they don’t have dyslipidaemia. The target LDL is 1,4 mM or a 50% reduction from baseline.

Blood pressure management

For patients without diabetes, the target is < 140/90 mmHg. For patients with diabetes, the target is < 120/80 mmHg.

Anticoagulation

Anticoagulation is initiated in all patients with atrial fibrillation after ischaemic stroke. DOACs are preferred.

Carotid surgery

Carotid surgery is indicated for everyone with a 70 – 99% carotid stenosis. This involves carotid endarterectomy or carotid artery stenting.

Blood glucose management

For patients with diabetes. Target is < 7% (53 mmol/mol)


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