Medical therapy for secondary prevention of stroke.

The identification and modification of risk factors for stroke and their appropriate management can lead to reduction of stroke incidence. The real impact on recurrences of risk factors associated with lifestyles has not been thoroughly investigated, and the possible role of their modification in secondary prevention is principally extrapolated from primary prevention studies. On the other hand, several pathological conditions such as hypertension, atrial fibrillation, carotid stenosis, and diabetes are known to favour the risk of recurrence. Available antiplatelet regimens offer only partial protection against stroke and more efficacious antithrombotic agents would be useful. There is no doubt that warfarin is effective in preventing recurrence in stroke patients with atrial fibrillation. However, a careful etiological subtyping of stroke is recommended before starting treatment.