Although many strokes are preventable, it can be challenging to assess the risk versus benefit of therapy in individual patients, particularly regarding anticoagulation. Patients with atrial fibrillation generally require anticoagulation to reduce the risk of stroke, yet patients at highest risk often remain undertreated. Early antiplatelet therapy after minor stroke or transient ischaemic attack reduces risk of recurrent stroke.
- Paroxysmal or permanent atrial fibrillation associated with a CHA2DS2-VASc score of one or more for men and two or more for women should prompt consideration of anticoagulation to reduce stroke risk.
- High-risk patients with atrial fibrillation remain significantly undertreated; older patients, despite having a high risk of falls, are nevertheless likely to benefit from anticoagulation.
- Perioperative bridging anticoagulation for patients with atrial fibrillation is not routinely recommended; direct oral anticoagulant drugs should be ceased 24 to 48 hours before procedures.
- Asymptomatic carotid atherosclerotic disease should be treated medically.
- Antiplatelet medication for secondary prevention has most benefit when given early after stroke or transient ischaemic attack.
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