Ischemic Stroke Management: Posthospitalization and Transition of Care

Scott Larson; Brigit Ray; Jason Wilbur

Back

Ischemic Stroke Management: Posthospitalization and Transition of Care

Journal article

Peer reviewed

Ischemic Stroke Management: Posthospitalization and Transition of Care

Scott Larson, Brigit Ray and Jason Wilbur

American family physician, Vol.108(1), pp.70-77

07/01/2023

View Online

Abstract

Ischemic stroke is a major cause of morbidity and mortality worldwide. Ischemic stroke and transient ischemic attack exist on a continuum of the same disease process. Ischemic stroke is common, and more than 85% of stroke risk is attributed to modifiable risk factors. The initial management of acute stroke is usually performed in the emergency department and hospital settings. Family physicians have a key role in follow-up, ensuring that a complete diagnostic evaluation has been performed, addressing modifiable risk factors, facilitating rehabilitation, and managing chronic sequelae. Secondary prevention of ischemic stroke includes optimization of chronic disease management (e.g., hypertension, type 2 diabetes mellitus, dyslipidemia), nonpharmacologic lifestyle interventions (e.g., diet changes, exercise, substance use counseling), and pharmacologic interventions. Dual antiplatelet therapy with aspirin and clopidogrel is generally indicated for minor noncardioembolic ischemic strokes and high-risk transient ischemic attacks and should be converted to single antiplatelet therapy after 21 to 90 days. Secondary prevention of cardioembolic stroke requires long-term anticoagulation. Direct oral anticoagulants are preferred over warfarin for patients with nonvalvular atrial fibrillation. Poststroke problems with mobility, balance, cognition, dysphagia, and depression are common. Rehabilitation involves a multidisciplinary, multimodal approach that includes physical therapy, speech therapy, and treatment of chronic pain and poststroke depression. (Am Fam Physician. 2023; 108(1):70–77. Copyright © 2023 American Academy of Family Physicians.)

Cardiovascular Disease

Clinical Trials

Diabetes

Disease Prevention

Exercise

Genetic Disorders

Hypertension

Medical Imaging

Metabolic Disorders

Mutation

Physical Fitness

Stroke

Aspirin

Blood pressure

Blood tests

Cardiac arrhythmia

Diet

Drug use

Heart attacks

Laboratories

Lifestyles

Lipids

Patients

Risk factors

Transient ischemic attack

Details

Title: Subtitle: Ischemic Stroke Management: Posthospitalization and Transition of Care
Creators: Scott Larson
Brigit Ray
Jason Wilbur
Resource Type: Journal article
Publication Details: American family physician, Vol.108(1), pp.70-77
Publisher: American Academy of Family Physicians
ISSN: 0002-838X
eISSN: 1532-0650
Language: English
Date published: 07/01/2023
Academic Unit: Family Medicine
Record Identifier: 9984444869302771

Metrics

1 Record Views