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The devastation of an acute stroke is something relatively few of us have experienced personally, but professionally we see it very regularly. An estimated 690,000-plus adults in the United States suffer an ischemic stroke annually, and an additional 240,000 experience a transient ischemic attack.
The good news is that the current estimated annual rate of future stroke in this patient population (3%-4%) is historically low, thanks to preventive measures, according to the new "Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals," which was published online in Stroke in May (Stroke 2014 May 1 [doi: 10.1161/STR.0000000000000024]). This updated guideline gives evidence-based recommendations on secondary stroke prevention as well as primary prevention in those who have suffered a transient ischemic attack (TIA).
This very extensive guide from the American Heart Association and the American Stroke Association addresses a wide variety of scenarios, ranging from general risk factor modification to specific circumstances, such as myocardial infarction and thrombus, cardiomyopathy, pregnancy, arterial dissection, and aortic arch atherosclerosis.
I welcome the recommendation to consider adding clopidogrel 75 mg/day to aspirin for 90 days in patients with a recent (within 30 days) stroke or TIA attributable to high-grade stenosis (70%-99%) of a major intracranial artery. I used to feel rather helpless to improve the long-term outcome in these patients, but now there seems to be something more we can do, other than just using statins and single antiplatelet therapy.
Other new recommendations stress nutrition. One item suggests performing a nutritional assessment for patients with a history of ischemic stroke or TIA. While many patients may never get around to seeing a nutritionist as an outpatient, no matter how often their primary care physician stresses the importance, when they are in the hospital we have a captive audience. So why not order a nutrition consult, along with the consult for physical, occupational, and speech therapy?
After having experienced an acute neurologic event, many patients and their families are highly motivated to make whatever changes are necessary to prevent a future, potentially catastrophic stroke. Reduction of sodium from 3.3 g/day to 2.5 g/day or less is reasonable, according to the guidelines, though lowering intake to less than 1.5 g/day will lower blood pressure even further. A nutritionist’s input into how to attain these levels without eating a diet that tastes like cardboard can be invaluable. The new guidelines also suggest counseling patients to follow a Mediterranean-type diet – emphasizing whole grains, fruits, vegetables, nuts, olive oil, legumes, fish, poultry, and even low-fat dairy products – instead of the traditional low fat diet.
These new recommendations are only the tip of the iceberg, and this document is highly worthwhile for all practicing clinicians.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].
The devastation of an acute stroke is something relatively few of us have experienced personally, but professionally we see it very regularly. An estimated 690,000-plus adults in the United States suffer an ischemic stroke annually, and an additional 240,000 experience a transient ischemic attack.
The good news is that the current estimated annual rate of future stroke in this patient population (3%-4%) is historically low, thanks to preventive measures, according to the new "Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals," which was published online in Stroke in May (Stroke 2014 May 1 [doi: 10.1161/STR.0000000000000024]). This updated guideline gives evidence-based recommendations on secondary stroke prevention as well as primary prevention in those who have suffered a transient ischemic attack (TIA).
This very extensive guide from the American Heart Association and the American Stroke Association addresses a wide variety of scenarios, ranging from general risk factor modification to specific circumstances, such as myocardial infarction and thrombus, cardiomyopathy, pregnancy, arterial dissection, and aortic arch atherosclerosis.
I welcome the recommendation to consider adding clopidogrel 75 mg/day to aspirin for 90 days in patients with a recent (within 30 days) stroke or TIA attributable to high-grade stenosis (70%-99%) of a major intracranial artery. I used to feel rather helpless to improve the long-term outcome in these patients, but now there seems to be something more we can do, other than just using statins and single antiplatelet therapy.
Other new recommendations stress nutrition. One item suggests performing a nutritional assessment for patients with a history of ischemic stroke or TIA. While many patients may never get around to seeing a nutritionist as an outpatient, no matter how often their primary care physician stresses the importance, when they are in the hospital we have a captive audience. So why not order a nutrition consult, along with the consult for physical, occupational, and speech therapy?
After having experienced an acute neurologic event, many patients and their families are highly motivated to make whatever changes are necessary to prevent a future, potentially catastrophic stroke. Reduction of sodium from 3.3 g/day to 2.5 g/day or less is reasonable, according to the guidelines, though lowering intake to less than 1.5 g/day will lower blood pressure even further. A nutritionist’s input into how to attain these levels without eating a diet that tastes like cardboard can be invaluable. The new guidelines also suggest counseling patients to follow a Mediterranean-type diet – emphasizing whole grains, fruits, vegetables, nuts, olive oil, legumes, fish, poultry, and even low-fat dairy products – instead of the traditional low fat diet.
These new recommendations are only the tip of the iceberg, and this document is highly worthwhile for all practicing clinicians.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].
The devastation of an acute stroke is something relatively few of us have experienced personally, but professionally we see it very regularly. An estimated 690,000-plus adults in the United States suffer an ischemic stroke annually, and an additional 240,000 experience a transient ischemic attack.
The good news is that the current estimated annual rate of future stroke in this patient population (3%-4%) is historically low, thanks to preventive measures, according to the new "Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals," which was published online in Stroke in May (Stroke 2014 May 1 [doi: 10.1161/STR.0000000000000024]). This updated guideline gives evidence-based recommendations on secondary stroke prevention as well as primary prevention in those who have suffered a transient ischemic attack (TIA).
This very extensive guide from the American Heart Association and the American Stroke Association addresses a wide variety of scenarios, ranging from general risk factor modification to specific circumstances, such as myocardial infarction and thrombus, cardiomyopathy, pregnancy, arterial dissection, and aortic arch atherosclerosis.
I welcome the recommendation to consider adding clopidogrel 75 mg/day to aspirin for 90 days in patients with a recent (within 30 days) stroke or TIA attributable to high-grade stenosis (70%-99%) of a major intracranial artery. I used to feel rather helpless to improve the long-term outcome in these patients, but now there seems to be something more we can do, other than just using statins and single antiplatelet therapy.
Other new recommendations stress nutrition. One item suggests performing a nutritional assessment for patients with a history of ischemic stroke or TIA. While many patients may never get around to seeing a nutritionist as an outpatient, no matter how often their primary care physician stresses the importance, when they are in the hospital we have a captive audience. So why not order a nutrition consult, along with the consult for physical, occupational, and speech therapy?
After having experienced an acute neurologic event, many patients and their families are highly motivated to make whatever changes are necessary to prevent a future, potentially catastrophic stroke. Reduction of sodium from 3.3 g/day to 2.5 g/day or less is reasonable, according to the guidelines, though lowering intake to less than 1.5 g/day will lower blood pressure even further. A nutritionist’s input into how to attain these levels without eating a diet that tastes like cardboard can be invaluable. The new guidelines also suggest counseling patients to follow a Mediterranean-type diet – emphasizing whole grains, fruits, vegetables, nuts, olive oil, legumes, fish, poultry, and even low-fat dairy products – instead of the traditional low fat diet.
These new recommendations are only the tip of the iceberg, and this document is highly worthwhile for all practicing clinicians.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].
