Secondary Stroke Prevention Strategies for the Oldest Patients

Abstract

Older adults are not only at higher risk of experiencing stroke, but also have multiple co-morbidities that make treatment for secondary stroke prevention challenging. Very few clinical trials specifically related to secondary stroke prevention treatment efficacy have focused on the oldest-old (≥85 years) and, therefore, evidence-based recommendations for treatment specific to this population are not available. Some of the special considerations for stroke prevention treatments in older patients include careful titration of blood-pressure-lowering drugs to avoid hypotension, the risk of haemorrhagic stroke with HMG-CoA reductase inhibitors (statins) and weighing the risk of recurrent ischaemia versus bleeding in patients taking antiplatelet or anticoagulant therapy. The risk of peri-procedural complications appears to be high with both carotid angioplasty and stenting and carotid endarterectomy in older patients with carotid stenosis. Other common issues in older patients include adverse drug events, recognizing the risk of dementia, depression and osteoporosis and deciding when to discontinue secondary stroke prevention. In this review, we provide the practitioner with the evidence related to specific approaches to secondary stroke prevention in older patients, and identify the knowledge gaps that currently limit our ability to appropriately treat this vulnerable population.

Study of Symptoms, Risk Factors and Prescribing Patterns in Cerebral Stroke Patients

“…2,7,19 It is the leading cause of death only next to cancer. 11,29,33 There are three types of strokes, which include Ischemic (88%) Hemorrhagic (12%) and Transient (rare type). 6,8,18 According to WHO, 15 million people worldwide suffer from stroke each year.…”

Risk Factors Associated with Recurrent Strokes in Young and Elderly Patients: A Hospital-based Study

“…For older men with a history of MI, the probability of having a recurrent stroke was 6.761 times that for stroke patients without such a history 16,17 . Similarly, in elderly men, DM was also a risk factor for recurrent stroke 18,19 . However, by contrast, our study found that in elderly men, HTN was not a strong risk factor for stroke recurrence.…”

Expert-System Based Medical Stroke Prevention

“…Although from this research it might seem that making substantial changes in lifestyle is not important, it is important to note that most of the biologic mechanisms by which different factors influence risk of a first time stroke are also likely to have effect on risk of recurrent stroke. However pharmacological therapy and life modifications are recommended for all patients who have had an ischaemic stroke or transient ischaemic attack (Bushnell and Colon-Emeric, 2009). …”