Prevention of Recurrent Ischemic Stroke

persons have a stroke; in 200,000 of these patients, the strokes are recurrent.1 Of the 500,000 patients with a new stroke, 14 percent will have a another stroke within one year. Approxi-mately 270,000 persons die each year because of stroke, ranking it third in mortality behind heart disease and cancer. Stroke leads to more long-term disability than any other disease process, and it directly and indirectly costs the United States $57.9 billion a year. Most strokes (88 percent) are ischemic. The rates of intracerebral hemorrhage and subarachnoid hemorrhage are much lower (9 and 3 percent, respectively).1 Recent trials use a mixture of clinical and radiographic evidence to define ischemic stroke versus transient ischemic attack (TIA). An ischemic stroke is defined as acute onset of neurologic symptoms lasting longer than 24 hours or radiographic evidence of an ischemic event in patients with loss of symptoms within 24 hours.2 A TIA is an event that lasts less than 24 hours and that is without evi-dence of pathology on radiographic studies.2 Although these terms are strict, the pathol-ogy and clinical significance overlap. Because most clinical trials include patients with ischemic stroke and TIA, and because it is probably just as important to prevent a recurrent TIA, this article will use the term “ischemic stroke ” to indicate both. In addition, this article will only discuss the management of noncardioembolic stroke and not atrial fibrillation or embolic stroke. Stroke survivors account for a significant proportion of family practice office visits, with one study finding that a stroke survivor has an average of 10 outpatient visits a year.3 Appropriate, cost-effective, office-based care of these patients is critical to minimize future disability and to reduce the risk of death from recurrent stroke. This article reviews the most current information on the prevention of recurrent ischemic stroke based on recent guide-lines from the American Heart Association, the American Stroke Association Coun-cil on Stroke, and the American Colleg