If you've had a stroke, you may be worried about having another. But there are treatments that can reduce your risk.
We've looked at the best and most up-to-date research to produce this information.
You can use it to talk to your doctor and decide which treatments are right for you.
A stroke happens when the blood supply to part of the brain is cut off. It's extremely dangerous. If brain cells go too long without a supply of blood, they will die.
It's also possible to have a mini-stroke. A mini-stroke happens when the blood supply to the brain is cut off for just a few minutes. Doctors call it a transient ischaemic attack, or
TIA.
If you've had a stroke or mini-stroke before, you're at an increased risk of having another one. Because strokes are so serious, it's important to try to reduce your risk. You may be particularly at risk if you're over 75; if you have heart failure, diabetes, or high blood pressure; or if you have a type of irregular heartbeat called atrial fibrillation.
Your doctor is likely to suggest you take medicines to reduce your risk of another stroke.
Some people may also benefit from surgery. Your doctor is also likely to suggest you make some changes to your lifestyle to help you stay healthy.
Medicines
If you've already had a stroke, taking drugs to lower your blood pressure can reduce your chances of having another. You may get a benefit even if your blood pressure isn't high to begin with. Several types of drug can reduce your blood pressure. Some of the most common are calcium channel blockers, diuretics, and ACE inhibitors. Ask your doctor which are best for you. You may also be able to reduce your blood pressure by making changes to your lifestyle. There's information about this below.
The drugs that are used to lower blood pressure can cause side effects. These are usually mild. Talk to your doctor if the side effects bother you. He or she may be able to reduce your dose or give you a different drug.
Taking a drug called a statin can also lower your chance of having another stroke. Statins are used to lower people's cholesterol level. However, even if your cholesterol is normal, taking a statin can cut your chance of a stroke. You can also lower your cholesterol by changing what you eat or by taking other drugs. But these don't seem to lower your risk of a stroke.
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Preventing another stroke
Statins can cause side effects, but they're rare. You'll have blood tests every so often to make sure your treatment doesn't damage your liver. Some people who take statins get muscle pains or muscle damage. Tell your doctor if you notice any muscle pain or weakness.
Taking aspirin every day can also cut your risk of another stroke. Some other drugs that work in a similar way to aspirin are clopidogrel (brand name Plavix) and dipyridamole
(Persantin). Doctors often recommend taking dipyridamole combined with aspirin, as this can further reduce your stroke risk. This combination is called Asasantin Retard.
As a side effect, aspirin can make you bleed more easily. There's a small risk that this could cause dangerous bleeding inside your body. But experts agree that the benefits outweigh the risks.
Surgery
Doctors sometimes recommend surgery to help prevent another stroke. An operation called carotid endarterectomy can remove any fatty build-up from the blood vessels in your neck. You'll have a general anaesthetic to make you sleep. A surgeon cuts into the blood vessels in your neck and removes any blockages. It's a serious operation, and it has risks. It's not suitable for everyone. For some people, it could actually increase their risk of a stroke. Talk to your doctor about whether surgery could be right for you.
There's another operation called carotid angioplasty. This uses a tube with a tiny balloon on the end. The tube is passed through your blood vessels, and the balloon is blown up to widen any blockages. This operation is fairly new, so it's not clear yet how well it works.
What if I have an irregular heartbeat?
If you have a type of irregular heartbeat called atrial fibrillation, the treatment you need will be slightly different. An irregular heartbeat can mean that blood pools in your heart and forms clots. If a clot travels to your brain, it can cause a stroke. So your doctor may suggest treatment to help prevent blood clots.
Doctors often prescribe drugs called anticoagulants. Until recently, most people were offered an anticoagulant called warfarin. However, newer anticoagulants are becoming more widely used. These include (with brand names): dabigatran (Pradaxa), rivaroxaban
(Xarelto), and apixaban (Eliquis). Anticoagulants stop new clots forming in your blood, or stop old clots getting bigger. If you have atrial fibrillation, taking an anticoagulant will lower your chances of having a stroke. In one study, about 9 in 100 people who took warfarin had another stroke. This compared with 23 in 100 people who weren't taking warfarin.
One drug that's used for this is warfarin. It's a type of drug called an anticoagulant.
Anticoagulants stop new clots forming in your blood, or stop old clots getting bigger. If you have atrial fibrillation, taking an anticoagulant will lower your chances of having a stroke. In one study, about 9 in 100 people who took warfarin had another stroke. This compared with 23 in 100 people who weren't taking warfarin.
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Preventing another stroke
As a side effect, anticoagulants can make you to bleed more easily. This can lead to dangerous bleeding inside your body. One review of the research found that 10 in 1,000 people who were taking aspirin or no treatment had dangerous bleeding. About 13 in
1,000 people who were taking warfarin had dangerous bleeding. If you're taking warfarin, you'll have regular blood tests to make sure you're taking the right dose. This reduces your risk of side effects. The newer anticoagulants don't require regular testing.
Aspirin is sometimes used to prevent blood clots for people who have an irregular heartbeat. It has fewer side effects than warfarin. But if you've had a stroke before, it doesn't help as much as warfarin.
What can I do to help myself?
Making changes to your lifestyle can help lower your blood pressure and your cholesterol level, and help you be healthier overall. There are several things that your doctor will probably advise you to do. But you'll still need to take the medicines that your doctor has prescribed.
If you smoke, your doctor will ask you to try to stop. Smoking damages your blood vessels and makes a stroke more likely. Your doctor or pharmacist can give you advice on giving up smoking.
If you're overweight, it's a good idea to try to get to a healthier weight. Doing some physical activity can help. Doing at least 30 minutes of exercise on most days is a good target.
Try to choose an activity that makes you warm and slightly out of breath. Many people find that walking briskly is the most convenient thing to do.
It's also important to eat a healthy diet. Try to eat at least five portions of fruit and vegetables each day. Avoid eating lots of salt, butter, or animal fat. If you drink alcohol, don't have too much.
If you have another medical condition, such as diabetes or a heart problem, try to make sure it's kept under control. Not taking your treatment for other conditions may also affect your risk of a stroke.
If you've had a stroke before, it can mean some big changes to your life. You may find it helps to talk to people who've been in a similar situation. Or, if you're caring for a relative who's had a stroke, you may feel you need more advice and support. Your doctor can give you advice and put you in touch with organisations that can help.
The Stroke Association is a charity that offers information and support to people who've had a stroke and their families. You can find out more at their website
(http://www.stroke.org.uk).
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Preventing another stroke
This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content. These leaflets are reviewed annually.
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Last published: Sep 16, 2015 page 4 of 4