A prospective cohort study in the United Kingdom demonstrated that vegetarians have a 22% lower incidence of ischemic heart disease, but a 20% increased incidence of total stroke, mostly related to hemorrhagic stroke, when compared to meat eaters. No difference in ischemic stroke or acute myocardial infarction was found.
The POINT trial showed a 25% reduction in the composite outcome of ischemic stroke, myocardial infarction, or ischemic vascular death in patients treated with clopidogrel plus aspirin for 90 days, immediately following a transient ischemic attack (TIA) or minor acute ischemic stroke. The investigators performed a secondary analysis and found the risk of major hemorrhages was low in both groups, although treatment with clopidogrel and aspirin together increased the risk of major hemorrhages over aspirin alone. Caution should be taken and very close observation of patients maintained when treating with dual antiplatelet therapies.
The Apple Heart Study participants were people without atrial fibrillation who purchased a smart phone app and consented to monitoring using a smartwatch-based irregular pulse notification algorithm, which identified possible atrial fibrillation. If notification occurred, the person was mailed an electrocardiography (ECG) patch to be worn for seven days to confirm the findings first identified by the smartwatch. The age distribution of this group is different than the usual cohort at risk for atrial fibrillation: 52% were between the ages of 22 and 39 years of age, and only 5.9% were 65 years or older. A much more useful study would have included an older cohort that carries a higher risk of atrial fibrillation.
High blood pressure is the most prevalent and important risk factor for stroke, and great efforts have been made to reduce blood pressure for both primary and secondary stroke prevention. However, at this time, we do not have evidence to support a firm recommendation for optimal blood pressure management for secondary stroke prevention.
Optimal antithrombotic therapy for stroke prevention in patients with atrial fibrillation continues to evolve.Monotherapy with rivaroxiban was noninferior to combination therapy for the primary efficacy endpoint.
Bridging therapy with intravenous thrombolysis appears to be associated with improved functional outcome without any additional complications compared to direct mechanical thrombectomy for patients with acute ischemic stroke who have LVOs.
The authors of this trial investigated the benefits and risks of early anticoagulation following acute ischemic stroke, and compared the effects of direct oral anticoagulants vs. vitamin K antagonists. Overall, treatment with direct oral anticoagulants resulted in a reduced risk of poor clinical outcomes, primarily due to reduced risk of intracerebral hemorrhage.