Stroke: Long-Term Poststroke Management

Abstract

It is estimated that after stroke patients live 33% fewer remaining years compared with age- and sex-matched controls. Functional recovery after stroke depends on many factors, including age, functional status before stroke, stroke severity, and comorbidities. The purpose of rehabilitation services is to improve functional status. All patients with stroke should undergo a formal assessment of rehabilitation needs before hospital discharge. Types of rehabilitation include inpatient, subacute, and home health care. Primary care of patients after stroke focuses on secondary stroke prevention, including antiplatelet therapy, hypertension and hyperlipidemia management, diet, and glycemic control. In patients with ischemic stroke and no contraindications, dual antiplatelet therapy with aspirin and clopidogrel is recommended for 21 to 90 days after stroke, but not longer. A blood pressure goal of less than 130/80 mm Hg is recommended for most patients. For most patients with diabetes, a goal A1c level of 7% or less is reasonable. Diabetes management should include a glucagon-like peptide 1 receptor agonist or sodium-dependent glucose cotransporter 2 inhibitor. Various tests, drugs, and screenings are indicated for patients with specific hypercoagulable states (eg, coagulopathies, antiphospholipid syndrome, occult malignancy, hormone therapy). Poststroke follow-up should address sequelae, such as fatigue, depression, contracture and spasticity, hemiplegic shoulder pain, and central poststroke pain.