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Review
. 2025 Jul;56(7):1938-1946.
doi: 10.1161/STROKEAHA.124.050403. Epub 2025 Apr 21.

Dilemmas in Secondary Stroke Prevention

Stephanie Vu  1 , Noor Mahmoud  1 , Shravan Sivakumar  1 , Forough Yazdanian  2 , Marc Fisher  1
Affiliations
Review

Dilemmas in Secondary Stroke Prevention

Stephanie Vu et al. Stroke. 2025 Jul.

Abstract

Secondary stroke prevention encompasses many approaches, including antithrombotic therapy, risk factor management, and a healthy lifestyle. Recommendations are typically based on the results of randomized clinical trials that provide evidence of benefit. However, in some situations, clinicians extrapolate the results of clinical trials into everyday practice, or trials have not provided sufficient information to make treatment decisions. This review will discuss 4 scenarios: dual-antiplatelet therapy, the perils of combining antiplatelet and anticoagulation, indications for statin therapy, and therapeutic considerations for patients with paroxysmal atrial fibrillation.

Keywords: anticoagulants; cerebral infarction; fibrinolytic agents; ischemic attack, transient; platelet aggregation.

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Conflict of interest statement

Dr Fisher serves as a consultant to Lumosa, Neurodawn, Revalesio, and Simcere. He is also a member of the data and safety monitoring board for Moleac and is employed by Beth Israel Deaconess Medical Center. Notably, these disclosures are not pertinent to the content of this article. The other authors report no conflicts.

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