Stroke treatment and prevention. Indications for thrombolysis. Risk factors.
Risk Factors and Prevention
Various risk factors contribute to the likelihood of experiencing a stroke. Understanding and addressing these factors are crucial for effective prevention.
Common risk factors include:
- Arterial Hypertension: Elevated blood pressure increases the risk of stroke.
- Diabetes: Individuals with diabetes have an elevated risk of stroke.
- Dyslipidemia: Abnormal levels of lipids in the blood, such as high cholesterol, contribute to stroke risk.
- Smoking: Tobacco smoke contains chemicals that can damage blood vessels, raising the risk of stroke.
- Obesity: Excess body weight, especially around the abdomen, is associated with an increased risk of stroke.
- Excessive Alcohol: Consuming alcohol beyond recommended limits can contribute to stroke risk.
- Physical Inactivity: Lack of regular exercise is a risk factor for stroke.
- Transient Ischemic Attack (TIA): A history of TIAs can indicate an increased risk of a subsequent stroke.
- Certain Blood Disorders: Conditions affecting blood clotting can contribute to stroke risk.
- Heart Failure: Impaired heart function can lead to an increased risk of stroke.
- Carotid Stenosis: Narrowing of the carotid arteries raises the risk of stroke.
- Irregular Rhythm in Atrial Fibrillation: Atrial fibrillation increases the risk of blood clots and stroke.
- Cancer: Both the presence of cancer and certain cancer treatments can predispose individuals to a hypercoagulable state, increasing the risk of stroke.
- Thrombophilia: Conditions characterized by abnormal blood clotting, such as thrombophilia, can elevate the risk of stroke.
Prevention Strategies
Approximately 80% of premature strokes and heart diseases can be prevented through healthy behaviors.
Effective prevention strategies include:
- Healthy Lifestyle Choices:Choosing nutritious foods, limiting alcohol intake, avoiding smoking, and engaging in regular physical activity contribute to overall well-being and reduce stroke risk.
- Weight Management:Maintaining a healthy weight is crucial for preventing stroke.
- Regular Physical Activity:Incorporating regular exercise into one’s routine helps manage weight and promotes cardiovascular health.
- Limiting Alcohol:Moderating alcohol consumption lowers the risk of stroke.
- No Smoking:Quitting smoking reduces the risk of stroke and improves overall health.
- Control of Health Conditions:Collaborating with healthcare professionals to manage conditions like cholesterol levels, blood pressure, and diabetes effectively.
By adopting a proactive approach to these risk factors and embracing a healthy lifestyle, individuals can significantly reduce their risk of experiencing a stroke. Regular check-ups and working closely with healthcare teams play a pivotal role in preventing and managing stroke risk factors.
Treatment for Ischemic Stroke
If an individual has experienced an ischemic stroke, a combination of medicines is typically recommended to address the current condition and prevent future occurrences. The choice of medications may vary, and some are administered immediately for a short duration, while others are initiated post-treatment and may be required long term.
- Thrombolysis – “Clot Buster” Medicine:
Alteplase: This “clot-busting” medicine dissolves blood clots, restoring blood flow to the brain. It is most effective when administered as soon as possible after the stroke, ideally within 4.5 hours. A brain scan is essential before using alteplase to confirm an ischemic stroke diagnosis, as the medicine can exacerbate bleeding in hemorrhagic strokes. Not everyone is suitable for thrombolysis, and contraindications may include a recent brain bleed, inability to determine symptom onset, delayed hospital arrival, bleeding disorders, recent major surgery, a prior stroke or head injury within the past three months, and incompatible current medications.
- Thrombectomy:
In severe cases of ischemic strokes caused by a blood clot in a large brain artery, an emergency procedure called thrombectomy may be performed. This procedure involves the removal of blood clots to restore blood flow to the brain. Thrombectomy is most effective when initiated promptly after a stroke, ideally within the first 6 hours of symptoms onset.
- Antiplatelets (like aspirin) and anticoagulants:
Both anti platelets and anticoagulants aim to prevent the formation of blood clots within the blood vessels, but their mechanisms of action differ.
Antiplatelet medication work by disrupting the binding or aggregation of platelets. Platelets play a crucial role in initiating the formation of blood clots in response to vascular injury. By interfering with platelet function, anti platelets reduce the likelihood of clots forming and help prevent condition such as stroke.
Immediately following an ischemic stroke, most individuals are administered aspirin to prevent further clot formation and commonly prescribed for individuals with a history of transient ischemic attacks or ischemic strokes to reduce the risk of future events.
On the other hand, anticoagulants target the proteins involved in the coagulation process of blood. These proteins, known as clotting factors, thereby slowing down or preventing the clotting cascade. Different anticogaulants may target different factors in the coagulation pathway, offering a range of options for preventing and treating conditions.
Anticoagulants are less commonly used in the acute phase of an ischemic stroke due to the risk of bleeding and considered for specific conditions that pose a higher risk of blood clot formation in the heart such as atrial fibrillation.
The choice between anti platelets and anticoagulants is often influenced by factors such as the cause of the stroke, the presence of specific medical condition and risk of bleeding.
The choice of treatment is individualized based on factors such as the type and severity of the stroke, the presence of risk factors, and the patient’s medical history. Swift intervention, accurate diagnosis, and a comprehensive treatment plan contribute to improved outcomes for individuals who have suffered an ischemic stroke.
References
Warning signs of a stroke: symptoms to look for and how to get the right care: HealthPartners: https://www.healthpartners.com/blog/stroke-warning-signs-symptoms/ Stroke: Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/5601-stroke
NIHSS: https://www.physio-pedia.com/NIH_Stroke_Scale
Clinical symptoms: https://www.myamericannurse.com/identify-the-vessel-recognize-the-stroke/
Prevention: https://www.cdc.gov/stroke/prevention.htm Treatment: https://www.nhs.uk/conditions/stroke/treatment/
Antiplatelents and anticoagulants: https://www.healthline.com/health/anticoagulant-and-antiplatelet-drugs#what-they-do
Anticoagulants: https://emedicine.medscape.com/article/1160021-overview Antiplatelets: https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.118.023954
Verified by Dr. Petya Stefanova
