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Systematic Stroke Prevention

Bushnell, Cheryl MD, MHS; Reynolds, Patrick MD

doi: 10.1212/01.CON.0000410038.72594.4a
Review Articles

Purpose of Review: This review summarizes the systematic approaches that can be used to optimize secondary stroke prevention. Systematic secondary stroke prevention involves not only prescribing stroke patients the appropriate medications to manage risk factors, but also optimizing the effectiveness of those drugs by focusing on medication adherence. Medication adherence is defined as the extent to which patients take their medications as prescribed by their providers.

Recent Findings: Many potential barriers to adherence exist, including relationships among patient, provider, and the health system. Medication reconciliation at discharge and early follow-up are steps that may increase medication adherence, decrease medication errors, and improve the transition to home. In addition, inclusion of the primary provider or stroke specialist in decisions regarding the management of antithrombotic therapy for procedures is important, as discontinuing these medications is often associated with recurrent ischemic events.

Summary: Prevention of recurrent stroke should be a priority for patients, caregivers, providers, and health systems. Medication-taking behavior should be considered from all of these perspectives in order to optimize adherence.

Address correspondence to Dr Cheryl Bushnell, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157,

Relationship Disclosure: Dr Bushnell receives salary support from the NIH. Dr Reynolds reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Bushnell and Reynolds report no disclosure.

© 2011 American Academy of Neurology
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