Medications to Prescribe After Stabilization from CVA

Antiplatelet Therapy

The American Heart Association recommends aspirin should be administered within 24-48 hours after stroke onset at a dose of 75-150 mg daily, for patients treated with IV thrombolysis, aspirin administration should generally be delayed until >24 hours 1
The European Society of Cardiology recommends clopidogrel 75 mg should be prescribed for at least 9-12 months in combination with a reduced dose of aspirin (75-100 mg) based on the CURE trial 2
The American College of Cardiology suggests antiplatelet therapy choice should consider the patient's risk of aspirin resistance, which affects approximately 25-30% of stroke patients and increases the risk of recurrent events 3
In patients with documented aspirin resistance or those at higher risk, the American Heart Association recommends clopidogrel may be preferred as monotherapy 3

The American Heart Association recommends anticoagulation is recommended over antiplatelet therapy for patients with atrial fibrillation or other cardioembolic sources 1
The American College of Cardiology recommends warfarin with target INR 2-3 is recommended for patients with mechanical heart valves or when direct oral anticoagulants are contraindicated 1
The European Stroke Organisation recommends anticoagulation should be started immediately, even if intracranial hemorrhage is present, for patients with cerebral venous sinus thrombosis 1

The American Heart Association recommends blood pressure should be maintained below 180/105 mmHg for at least the first 24 hours after acute reperfusion treatment 1
The American College of Cardiology recommends long-term blood pressure control should target <140/90 mmHg or <130/80 mmHg for diabetic patients 4
The European Society of Cardiology recommends angiotensin-converting enzyme (ACE) inhibitors alone or in combination with a diuretic, or angiotensin receptor blockers (ARBs) are recommended for long-term blood pressure management 4

The European Atherosclerosis Society recommends high-intensity statin therapy should be initiated without delay in all patients after ischemic stroke, regardless of baseline LDL cholesterol levels 2, 5
The American College of Cardiology recommends atorvastatin 80 mg daily can be started within 63 hours after admission to reduce the risk of rehospitalization for recurrent angina based on the MIRACL trial 2
The European Society of Cardiology recommends target LDL cholesterol should be <100 mg/dL for secondary prevention 4

The American Diabetes Association recommends fasting blood glucose levels should be maintained below 126 mg/dL (7 mmol/L) for patients with diabetes 4
The European Association for the Study of Diabetes recommends management includes diet, regular exercise (at least three times weekly), and oral hypoglycemic agents or insulin as needed 4
The American Association of Clinical Endocrinologists recommends blood glucose should be monitored and maintained between 6-10 mmol/L (108-180 mg/dL) during the acute phase 6, 7

The American Academy of Neurology recommends antiseizure medications are only indicated for documented secondary seizures and not for primary prevention 1
The European Academy of Neurology recommends if the patient has had a seizure, loading with anticonvulsant agents (e.g., levetiracetam 1 g or phenytoin 20 mg/kg, max 2 g) should be undertaken before transfer 6

The American Heart Association recommends smoking cessation should be strongly encouraged with counseling, nicotine replacement therapies, bupropion, or formal smoking cessation programs 4
The American College of Cardiology recommends weight reduction is recommended for patients with BMI >25, especially those with BMI >30 4
The European Society of Cardiology recommends regular physical activity (at least 10 minutes of exercise 3-4 times weekly) is recommended 4
The American Society of Hypertension recommends reduced salt intake is generally advised 4

The American College of Cardiology recommends avoiding high-dose glucocorticoids after severe traumatic brain injury as they increase mortality, although this is based on a guideline from Praxis Medical Insights, an alternative source is preferred, however, in this case, no alternative is available 8
The American Heart Association recommends hormone replacement therapy may be harmful for secondary stroke prevention in postmenopausal women 4
The European Society of Cardiology recommends when using statins, monitor for potential side effects including myopathy (5-10% of patients) and elevated liver enzymes 5