The ABCs of Stroke Prevention

“Your father has had a bad stroke” the physician told my mother as I stood by her side. Definitely one of the worst days of my life. And he was being truthful. My father spent three months in the hospital, in and out of ICU. But when he got to rehab, he slowly but steadily began recovering and was ultimately able to come home. A gift we were given and were determined not to waste. That’s when stroke prevention took on a whole new meaning for me. I had advised hundreds of patients about stroke prevention and now I had to put that advice into action.

Some of it was simple - take a full strength aspirin and your cholesterol lowering medicine every day and no missed doses please! Fortunately, I had been able to convince him to stop smoking some years ago, so that was a battle we had already won, but his prior smoking definitely contributed to his having a stroke.

My dad was very sensitive to his high blood pressure medications and it took a while to get him on a program that worked and that he could tolerate - but his primary care doc was a saint and saw him frequently and worked with him to get it right.

Mom is a great cook and she took her role of providing healthy meals very seriously. She managed to make great dishes that were packed with flavor and still low fat and low salt. She was inspired by magazines and TV cooking shows which focused on healthy foods.

And then the toughest one for our family—exercise. I promised my pop that I would walk with him every day. We didn’t quite make every day, but we did manage it several times a week. And the best part of that was we talked while walking and I got to know my father better than I ever would have before the stroke. And that was an amazing gift to me that came out of this effort to prevent him from having another stroke!

And so we ultimately had him with us for another decade before he passed. But he never had another stroke and I came to the know the ABCs of stroke prevention in a whole new way!

Secondary Prevention of Stroke

Secondary prevention can be summarized by the mnemonic A, B, C, D, E, as follows:

• A - Antiaggregants (aspirin, clopidogrel, extended-release dipyridamole, ticlopidine) and anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban, warfarin).
• B - Blood pressure–lowering medications
• C - Cessation of cigarette smoking, cholesterol-lowering medications, carotid revascularization
• D - Diet
• E – Exercise

By: Edward Hamaty, Jr., D.O., FACCP, FACOI; Chairman, Department of Critical Care Medicine