New Findings in Primary and Secondary Stroke Prevention

Based on selected publications from 2012, current developments and innovations in primary and secondary prevention of stroke are reviewed. In patients with atrial fibrillation, renal disease is an independent risk factor for stroke. Physical activity for 90 minutes per week reduces the risk of stroke. Aspirin (acetylsalicylic acid) is not recommended for primary prevention of stroke because it increases the risk of bleeding complications. Statin therapy does not increase the risk of intracranial haemorrhage. Nimodipine remains the only effective non-invasive medical option for vasospasm in subarachnoid haemorrhage. The combination of aspirin and clopidogrel increases the risk of bleeding complications in patients with minor lacunar stroke. Vorapaxar increases the risk of intracranial bleeding and is not recommended for stroke prevention. Data from the first randomised trial indicate that endovascular closure of a patent foramen ovale (PFO) in patients with cryptogenic stroke does not prevent recurrent stroke over a follow-up of 2 years. Extra-/intracranial cerebral artery bypass operation is not effective for secondary stroke prevention in patients with haemodynamically relevant carotid artery occlusion. The novel oral anticoagulant drugs are also effective in patients with atrial fibrillation and prior stroke.