Strategies for preventing stroke.

The limited effectiveness of any therapy for acute stroke dictates that emphasis be placed on strategies for preventing stroke. The identification and management of risk factors is paramount. Modifiable risk factors include hypertension, smoking, hyperlipidemia, and diabetes. Patients with transient ischemic attacks or stroke are at risk for recurrent stroke and should be considered for antithrombotic therapy and carotid endarterectomy. Patients with nonvalvular atrial fibrillation should also be treated with antithrombotic therapy. The proper management of other cardiac, malignant, and hematologic disorders is important in preventing stroke in these high-risk patients.