Medical prevention of secondary stroke: a cardiologist's perspective.

Post-stroke patients are at greatest risk from a second stroke rather than an event in another vascular bed. Thus treatment strategies must be aimed at preventing recurrent stroke. Recent evidence suggests that the pathophysiology underlying stroke may differ from that of coronary artery disease. Secondary events may replicate primary events, and treatment strategies for patients who experienced an initial stroke must therefore focus on preventing recurrent stroke. Medical strategies for secondary stroke prevention focus on four areas: control of hypertension, control of blood lipids, anticoagulant therapy, and treatment with antiplatelet agents such as aspirin, clopidogrel, and aspirin combined with extended-release dipyridamole, all of which the American College of Chest Physicians deems acceptable for first-line treatment for preventing secondary stroke.