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Stroke
A guide for patients and carers
How can I reduce the risk of another stroke?
There are several things you can do to reduce the chances of having another stroke:
Diet
A healthy diet, low in fat and high in fibre, will help keep your weight down and cholesterol low. By avoiding too much salt and excessive alcohol you can reduce your blood pressure, which might reduce the need for blood pressure drugs and will help prevent further strokes. If your cholesterol level is high or even normal your doctor may prescribe a drug to lower your cholesterol level.
Smoking
This increases the risk of further strokes as well as other health problems, so you should give up smoking if at all possible. Nicotine patches or gum used in consultation with your doctor will improve your chances of successfully giving up. It may help if you can avoid the situations in which you normally “light up” (e.g. sitting down after a meal). If possible, anyone else who smokes in your home should give up at the same time.
Blood pressure
If your blood pressure is consistently high after a stroke, lowering it by taking tablets will reduce the risk of further strokes. Losing weight, exercising regularly and avoiding excessive alcohol and salt in your food will all help keep your blood pressure low.
Aspirin
An aspirin tablet (75mg, 150mg or 300mg) each day reduces the risk of further strokes and heart attacks by making the blood less sticky. It probably does not make much difference which dose your doctor prescribes, although a lower dose may cause less indigestion. Aspirin is not recommended for patients with haemorrhagic strokes due to a burst blood vessel. It should normally be started as soon as possible after a CT scan has been done to make sure that an artery has not burst. Most people will remain on aspirin indefinitely unless they develop side effects.
Dipyridamole (also known as Persantin Retard)
This drug acts in a similar way to aspirin and can be taken in combination with aspirin. It is sometimes recommended for those people who have had a stroke or heart attack whilst on aspirin alone or who for some reason cannot take aspirin.
Clopidogrel (also known as Plavix)
This drug is another alternative to aspirin after stroke or TIA and is also used for people with heart disease or arterial problems in the legs. It is sometimes given in addition to aspirin.
Anticoagulants
For people who have a blocked blood vessel in the brain or who have had a recent heart attack, or have an abnormal heart rhythm or an artificial heart valve, anticoagulants (usually Warfarin) are recommended to prevent further strokes. Except in unusual circumstances, it is usually best to avoid taking aspirin and Warfarin together. Your doctor will advise you about this.
Surgery
A small number of people who have had a stroke due to a blocked blood vessel in the brain will have a very narrow (but not completely blocked) artery in the neck. Removing the narrowing in the artery with an operation called a carotid endarterectomy may reduce the risk of further strokes. The operation is quite a simple one and patients are not usually in hospital for more than five or six days.
The operation is not suitable for everyone and is usually only offered to those with severe narrowing of the artery (where its diameter is reduced by more than 70 or 80 per cent) who have had symptoms within six months. Unfortunately there is a small risk that the surgery itself will cause a stroke - you and your doctor will have to balance the benefits of surgery against this small risk. If you have a narrowed artery in your neck you need to discuss this option with the specialist looking after you.
A recently developed alternative is to stretch the narrowed artery with a balloon (percutaneous transluminal angioplasty). The artery may then be kept open by inserting a tubular wire mesh (carotid stenting). This is still being tested and is not yet in routine use.
A healthy diet, low in fat and high in fibre, will help keep your weight down and cholesterol low. By avoiding too much salt and excessive alcohol you can reduce your blood pressure, which might reduce the need for blood pressure drugs and will help prevent further strokes. If your cholesterol level is high or even normal your doctor may prescribe a drug to lower your cholesterol level.
Smoking
This increases the risk of further strokes as well as other health problems, so you should give up smoking if at all possible. Nicotine patches or gum used in consultation with your doctor will improve your chances of successfully giving up. It may help if you can avoid the situations in which you normally “light up” (e.g. sitting down after a meal). If possible, anyone else who smokes in your home should give up at the same time.
Blood pressure
If your blood pressure is consistently high after a stroke, lowering it by taking tablets will reduce the risk of further strokes. Losing weight, exercising regularly and avoiding excessive alcohol and salt in your food will all help keep your blood pressure low.
Aspirin
An aspirin tablet (75mg, 150mg or 300mg) each day reduces the risk of further strokes and heart attacks by making the blood less sticky. It probably does not make much difference which dose your doctor prescribes, although a lower dose may cause less indigestion. Aspirin is not recommended for patients with haemorrhagic strokes due to a burst blood vessel. It should normally be started as soon as possible after a CT scan has been done to make sure that an artery has not burst. Most people will remain on aspirin indefinitely unless they develop side effects.
Dipyridamole (also known as Persantin Retard)
This drug acts in a similar way to aspirin and can be taken in combination with aspirin. It is sometimes recommended for those people who have had a stroke or heart attack whilst on aspirin alone or who for some reason cannot take aspirin.
Clopidogrel (also known as Plavix)
This drug is another alternative to aspirin after stroke or TIA and is also used for people with heart disease or arterial problems in the legs. It is sometimes given in addition to aspirin.
Anticoagulants
For people who have a blocked blood vessel in the brain or who have had a recent heart attack, or have an abnormal heart rhythm or an artificial heart valve, anticoagulants (usually Warfarin) are recommended to prevent further strokes. Except in unusual circumstances, it is usually best to avoid taking aspirin and Warfarin together. Your doctor will advise you about this.
Surgery
A small number of people who have had a stroke due to a blocked blood vessel in the brain will have a very narrow (but not completely blocked) artery in the neck. Removing the narrowing in the artery with an operation called a carotid endarterectomy may reduce the risk of further strokes. The operation is quite a simple one and patients are not usually in hospital for more than five or six days.
The operation is not suitable for everyone and is usually only offered to those with severe narrowing of the artery (where its diameter is reduced by more than 70 or 80 per cent) who have had symptoms within six months. Unfortunately there is a small risk that the surgery itself will cause a stroke - you and your doctor will have to balance the benefits of surgery against this small risk. If you have a narrowed artery in your neck you need to discuss this option with the specialist looking after you.
A recently developed alternative is to stretch the narrowed artery with a balloon (percutaneous transluminal angioplasty). The artery may then be kept open by inserting a tubular wire mesh (carotid stenting). This is still being tested and is not yet in routine use.
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Page 13 of 15
Contents
- Introduction
- What is a stroke?
- What is a transient ischaemic attack?
- What are the symptoms of a stroke?
- What causes a stroke?
- What happens if you have a stroke?
- What tests will the doctor do?
- How are strokes treated?
- Common problems after severe strokes
- Will I recover?
- How will lifestyle be affected?
- What are the risks of a further stroke?
- How can I reduce the risk of another stroke?
- Conclusion
- Other organisations that may be able to help
