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Diagnosis and Management of Ischemic Stroke

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Comprehensive Cardiovascular Medicine in the Primary Care Setting

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Until relatively recently, ischemic stroke management was a classic example of “diagnose and adios.” Care of patients presenting to the hospital or clinic with symptoms of stroke consisted of aspirin followed by rehabilitation, with few disease-specific strategies directed toward optimal treatment and outcomes. The past two decades have witnessed an explosion of research into ischemic stroke. We now have specific therapies and management strategies to reduce morbidity and mortality. This chapter will first discuss the identification of patients with ischemic stroke, followed by acute treatment, in-patient management, and secondary stroke prevention.

Key Points

• The clinical diagnosis of acute ischemic stroke in the emergency room is based on clinical history, physical examination, and neuroimaging.

• Intravenous recombinant tissue plasminogen activator (tPA) is FDA approved for the treatment of acute ischemic stroke within 3 h of symptom onset, but is likely beneficial up to 4.5 h after onset.

• Hypoxia, fever, hypotension, hypertension, and hyperglycemia are associated with worse outcomes after ischemic stroke and should be managed appropriately.

• The in-patient evaluation consists of vascular imaging, echocardiography, and risk factor identification/management.

• Decompressive hemicraniectomy is a lifesaving procedure and should be considered in patients with large strokes involving more than two-thirds of the cerebral hemisphere.

• The first line of secondary stroke prevention is antiplatelet therapy.

• Management of risk factors such as hypertension, diabetes mellitus, dyslipidemia, and smoking is necessary to reduce the risk of recurrent cardiovascular events.

• Stroke patients with atrial fibrillation should be anticoagulated; if warfarin is contraindicated, then therapy with antiplatelet agents should be utilized.

• Carotid endarterectomy should be considered in symptomatic stenosis >50% and asymptomatic stenosis >60%.

• Carotid artery stenting has not been proven superior to endarterectomy.

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References

  1. Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–1711.

    Article  PubMed  Google Scholar 

  2. Khaja AM, Grotta JC. Established treatments for acute ischaemic stroke. Lancet. 2007;369:319–330.

    Article  PubMed  CAS  Google Scholar 

  3. Adams HP Jr, Adams RJ, Brott T, et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003;34:1056–1083.

    Article  PubMed  Google Scholar 

  4. Frankel MR, Morgenstern LB, Kwiatkowski T, et al. Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial. Neurology. 2000;55:952–959.

    Article  PubMed  CAS  Google Scholar 

  5. Muir KW, Weir CJ, Murray GD, et al. Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke. 1996;27:1817–1820.

    Article  PubMed  CAS  Google Scholar 

  6. Jacobs L, Kinkel WR, Heffner RR Jr. Autopsy correlations of computerized tomography: experience with 6,000 CT scans. Neurology. 1976;26:1111–1118.

    Article  PubMed  CAS  Google Scholar 

  7. Mullins ME, Schaefer PW, Sorensen AG, et al. CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology. 2002;224:353–360.

    Article  PubMed  Google Scholar 

  8. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–1587.

    Article  Google Scholar 

  9. Saver JL. Number needed to treat estimates incorporating effects over the entire range of clinical outcomes: novel derivation method and application to thrombolytic therapy for acute stroke. Arch Neurol. 2004;61:1066–1070.

    Article  PubMed  Google Scholar 

  10. Khaja AM. Acute ischemic stroke management: administration of thrombolytics, neuroprotectants, and general principles of medical management. Neurol Clin. 2008;26:943–961.

    Article  PubMed  Google Scholar 

  11. Katzan IL, Furlan AJ, Lloyd LE, et al. Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. JAMA. 2000;283:1151–1158.

    Article  PubMed  CAS  Google Scholar 

  12. Katzan IL, Hammer MD, Furlan AJ, et al. Quality improvement and tissue-type plasminogen activator for acute ischemic stroke: a Cleveland update. Stroke. 2003;34:799–800.

    Article  PubMed  CAS  Google Scholar 

  13. Barber PA, Zhang J, Demchuk AM, et al. Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology. 2001;56:1015–1020.

    Article  PubMed  CAS  Google Scholar 

  14. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004;363:768–774.

    Article  PubMed  Google Scholar 

  15. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3–4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–1329.

    Article  PubMed  CAS  Google Scholar 

  16. Qureshi AI. Endovascular treatment of cerebrovascular diseases and intracranial neoplasms. Lancet. 2004;363: 804–813.

    Article  PubMed  Google Scholar 

  17. Hacke W, Krieger D, Hirschberg M. General principles in the treatment of acute ishemic stroke. Cerebrovasc Dis. 1991;1(Suppl 1):93–99.

    Article  Google Scholar 

  18. Ronning OM, Guldvog B. Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke. 1999;30:2033–2037.

    Article  PubMed  CAS  Google Scholar 

  19. American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112(24 Suppl):IV1–IV203.

    Google Scholar 

  20. Oppel L. A review of the scientific evidence on the treatment of traumatic brain injuries and strokes with hyperbaric oxygen. Brain Inj. 2003;17:225–236.

    Article  Google Scholar 

  21. Azzimondi G, Bassein L, Nonino F, et al. Fever in acute stroke worsens prognosis. A prospective study. Stroke. 1995;26:2040–2043.

    Article  PubMed  CAS  Google Scholar 

  22. Hajat C, Hajat S, Sharma P. Effects of poststroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke. 2000;31:410–414.

    Article  PubMed  CAS  Google Scholar 

  23. Jorgensen HS, Reith J, Nakayama H, et al. What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke Study. Stroke. 1999;30:2008–2012.

    Article  PubMed  CAS  Google Scholar 

  24. The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–556.

    Article  Google Scholar 

  25. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–563.

    Article  PubMed  Google Scholar 

  26. Krieger DW, De Georgia MA, Abou-Chebl A, et al. Cooling for acute ischemic brain damage (cool aid): an open pilot study of induced hypothermia in acute ischemic stroke. Stroke. 2001;32:1847–1854.

    Article  PubMed  CAS  Google Scholar 

  27. Wang H, Olivero W, Lanzino G, et al. Rapid and selective cerebral hypothermia achieved using a cooling helmet. J Neurosurg. 2004;100:272–277.

    Article  PubMed  Google Scholar 

  28. Slotboom J, Kiefer C, Brekenfeld C, et al. Locally induced hypothermia for treatment of acute ischaemic stroke: a physical feasibility study. Neuroradiology. 2004;46:923–934.

    Article  PubMed  CAS  Google Scholar 

  29. Martin-Schild S, Hallevi H, Shaltoni H, et al. Combined neuroprotective modalities coupled with thrombolysis in acute ischemic stroke: a pilot study of caffeinol and mild hypothermia. J Stroke Cerebrovasc Dis. 2009;18:86–96.

    Article  PubMed  Google Scholar 

  30. Olsen TS, Weber UJ, Kammersgaard LP. Therapeutic hypothermia for acute stroke. Lancet Neurol. 2003;2:410–416.

    Article  PubMed  Google Scholar 

  31. Kocan MJ. Cardiovascular effects of acute stroke. Prog Cardiovasc Nurs. 1999;14:61–67.

    PubMed  CAS  Google Scholar 

  32. Korpelainen JT, Sotaniemi KA, Huikuri HV, et al. Abnormal heart rate variability as a manifestation of autonomic dysfunction in hemispheric brain infarction. Stroke. 1996;27:2059–2063.

    Article  PubMed  CAS  Google Scholar 

  33. Orlandi G, Fanucchi S, Strata G, et al. Transient autonomic nervous system dysfunction during hyperacute stroke. Acta Neurol Scand. 2000;102:317–321.

    Article  PubMed  CAS  Google Scholar 

  34. Afsar N, Fak AS, Metzger JT, et al. Acute stroke increases QT dispersion in patients without known cardiac diseases. Arch Neurol. 2003;60:346–350.

    Article  PubMed  Google Scholar 

  35. McDermott MM, Lefevre F, Arron M, et al. ST segment depression detected by continuous electrocardiography in patients with acute ischemic stroke or transient ischemic attack. Stroke. 1994;25:1820–1824.

    Article  PubMed  CAS  Google Scholar 

  36. Sacco RL, Adams R, Albers G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37:577–617.

    Article  PubMed  Google Scholar 

  37. Vemmos KN, Tsivgoulis G, Spengos K, et al. U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J Intern Med. 2004;255:257–265.

    Article  PubMed  CAS  Google Scholar 

  38. Johnston KC, Mayer SA. Blood pressure reduction in ischemic stroke: a two-edged sword? Neurology. 2003;61: 1030–1031.

    Article  PubMed  Google Scholar 

  39. Goldstein LB. Blood pressure management in patients with acute ischemic stroke. Hypertension. 2004;43:137–141.

    Article  PubMed  CAS  Google Scholar 

  40. Martin-Schild S. Blood pressure in acute stroke: lower it or let the CHHIPS fall where they will. Lancet Neurol. 2009;8:23–24.

    Article  PubMed  Google Scholar 

  41. Potter JF, Robinson TG, Ford GA, et al. Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial. Lancet Neurol. 2009;8:48–56.

    Article  PubMed  CAS  Google Scholar 

  42. The NINDS t-PA Stroke Study Group. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke. 1997;28:2109–2118.

    Article  Google Scholar 

  43. Larrue V, von Kummer R, del Zoppo G, et al. Hemorrhagic transformation in acute ischemic stroke. Potential contributing factors in the European Cooperative Acute Stroke Study. Stroke. 1997;28:957–960.

    Article  PubMed  CAS  Google Scholar 

  44. Bruno A, Biller J, Adams HP Jr, et al. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology. 1999;52:280–284.

    Article  PubMed  CAS  Google Scholar 

  45. Lindsberg PJ, Roine RO. Hyperglycemia in acute stroke. Stroke. 2004;35:363–364.

    Article  PubMed  Google Scholar 

  46. Candelise L, Landi G, Orazio EN, et al. Prognostic significance of hyperglycemia in acute stroke. Arch Neurol. 1985;42:661–663.

    Article  PubMed  CAS  Google Scholar 

  47. Griesdale DE, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180(8):821–827.

    Article  PubMed  Google Scholar 

  48. Finfer S, Heritier S. The NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation) Study: statistical analysis plan. Crit Care Resusc. 2009;11:46–57.

    PubMed  Google Scholar 

  49. Levetan CS. Effect of hyperglycemia on stroke outcomes. Endocr Pract. 2004;10(Suppl 2):34–39.

    PubMed  Google Scholar 

  50. Roberts TP, Rowley HA. Diffusion weighted magnetic resonance imaging in stroke. Eur J Radiol. 2003;45: 185–194.

    Article  PubMed  Google Scholar 

  51. Thulborn KR. MRI in the management of cerebrovascular disease to prevent stroke. Neurol Clin. 2008;26:897–921.

    Article  PubMed  Google Scholar 

  52. Atlas SW, Thulborn KR. MR detection of hyperacute parenchymal hemorrhage of the brain. Am J Neuroradiol. 1998;19:1471–1477.

    PubMed  CAS  Google Scholar 

  53. Gomori JM, Grossman RI. Mechanisms responsible for the MR appearance and evolution of intracranial hemorrhage. Radiographics. 1988;8:427–440.

    PubMed  CAS  Google Scholar 

  54. Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis—Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003;229:340–346.

    Article  PubMed  Google Scholar 

  55. Koelemay MJ, Nederkoorn PJ, Reitsma JB, et al. Systematic review of computed tomographic angiography for assessment of carotid artery disease. Stroke. 2004;35:2306–2312.

    Article  PubMed  Google Scholar 

  56. Jaff MR, Goldmakher GV, Lev MH, et al. Imaging of the carotid arteries: the role of duplex ultrasonography, magnetic resonance arteriography, and computerized tomographic arteriography. Vasc Med. 2008;13:281–292.

    Article  PubMed  Google Scholar 

  57. Homma S. Echocardiography in stroke patients (with emphasis on cryptogenic stroke). Rinsho Shinkeigaku. 2006;46:799–804.

    PubMed  Google Scholar 

  58. Ropper AH, Shafran B. Brain edema after stroke. Clinical syndrome and intracranial pressure. Arch Neurol. 1984;41: 26–29.

    Article  PubMed  CAS  Google Scholar 

  59. Wijdicks EF, Diringer MN. Middle cerebral artery territory infarction and early brain swelling: progression and effect of age on outcome. Mayo Clin Proc. 1998;73:829–836.

    Article  PubMed  CAS  Google Scholar 

  60. Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–222.

    Article  PubMed  Google Scholar 

  61. Hofmeijer J, Kappelle LJ, Algra A, et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8:326–333.

    Article  PubMed  Google Scholar 

  62. Kilpatrick CJ, Davis SM, Tress BM, et al. Epileptic seizures in acute stroke. Arch Neurol. 1990;47:157–160.

    Article  PubMed  CAS  Google Scholar 

  63. Lawes CM, Bennett DA, Feigin VL, et al. Blood pressure and stroke: an overview of published reviews. Stroke. 2004;35:776–785.

    Article  PubMed  Google Scholar 

  64. Rashid P, Leonardi-Bee J, Bath P. Blood pressure reduction and secondary prevention of stroke and other vascular events: a systematic review. Stroke. 2003;34:2741–2748.

    Article  PubMed  Google Scholar 

  65. Reichard P, Nilsson BY, Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med. 1993;329:304–309.

    Article  PubMed  CAS  Google Scholar 

  66. Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–2572.

    Article  PubMed  CAS  Google Scholar 

  67. Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–2559.

    Article  PubMed  CAS  Google Scholar 

  68. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–139.

    Article  PubMed  CAS  Google Scholar 

  69. Gorelick PB. Stroke prevention therapy beyond antithrombotics: unifying mechanisms in ischemic stroke pathogenesis and implications for therapy: an invited review. Stroke. 2002;33:862–875.

    Article  PubMed  Google Scholar 

  70. Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549–559.

    Article  PubMed  CAS  Google Scholar 

  71. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–2497.

    Article  Google Scholar 

  72. Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ. 1989;29:789–794.

    Article  Google Scholar 

  73. He J, Vupputuri S, Allen K, et al. Passive smoking and the risk of coronary heart disease—a meta-analysis of epidemiologic studies. N Engl J Med. 1999;340:920–926.

    Article  PubMed  CAS  Google Scholar 

  74. You RX, Thrift AG, McNeil JJ, et al. Ischemic stroke risk and passive exposure to spouses’ cigarette smoking. Melbourne Stroke Risk Factor Study (MERFS) Group. Am J Public Health. 1999;89:572–575.

    Article  PubMed  CAS  Google Scholar 

  75. Bonita R, Duncan J, Truelsen T, et al. Passive smoking as well as active smoking increases the risk of acute stroke. Tob Control. 1999;8:156–160.

    Article  PubMed  CAS  Google Scholar 

  76. Fiore MC. US public health service clinical practice guideline: treating tobacco use and dependence. Respir Care. 2000;45:1200–1262.

    PubMed  CAS  Google Scholar 

  77. Wannamethee SG, Shaper AG, Whincup PH, et al. Smoking cessation and the risk of stroke in middle-aged men. JAMA. 1995;274:155–160.

    Article  PubMed  CAS  Google Scholar 

  78. Kawachi I, Colditz GA, Stampfer MJ, et al. Smoking cessation in relation to total mortality rates in women. A prospective cohort study. Ann Intern Med. 1993;119:992–1000.

    PubMed  CAS  Google Scholar 

  79. Reynolds K, Lewis B, Nolen JD, et al. Alcohol consumption and risk of stroke: a meta-analysis. JAMA. 2003;289:579–588.

    Article  PubMed  Google Scholar 

  80. Kurth T, Gaziano JM, Berger K, et al. Body mass index and the risk of stroke in men. Arch Intern Med. 2002;162:2557–2562.

    Article  PubMed  Google Scholar 

  81. Lindenstrom E, Boysen G, Nyboe J. Lifestyle factors and risk of cerebrovascular disease in women. The Copenhagen City Heart Study. Stroke. 1993;24:1468–1472.

    Article  PubMed  CAS  Google Scholar 

  82. Anderson JW, Konz EC. Obesity and disease management: effects of weight loss on comorbid conditions. Obes Res. 2001;9(Suppl 4):326S–334S.

    Article  PubMed  Google Scholar 

  83. Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy—I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81–106.

    Article  Google Scholar 

  84. The Dutch TIA Study Group. The Dutch TIA trial: protective effects of low-dose aspirin and atenolol in patients with transient ischemic attacks or nondisabling stroke. Stroke. 1988;19:512–517.

    Article  Google Scholar 

  85. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71–86.

    Article  Google Scholar 

  86. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329–1339.

    Article  Google Scholar 

  87. Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331–337.

    Article  PubMed  CAS  Google Scholar 

  88. Diener HC, Cunha L, Forbes C, et al. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996;143:1–13.

    Article  PubMed  CAS  Google Scholar 

  89. Sacco RL, Diener HC, Yusuf S, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med. 2008;359:1238–1251.

    Article  PubMed  CAS  Google Scholar 

  90. Chaturvedi S, Bruno A, Feasby T, et al. Carotid endarterectomy—an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65:794–801.

    Article  PubMed  CAS  Google Scholar 

  91. Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–1501.

    Article  PubMed  CAS  Google Scholar 

  92. Mas JL, Trinquart L, Leys D, et al. Endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol. 2008;7:885–892.

    Article  PubMed  Google Scholar 

  93. Ricotta JJ 2nd, Malgor RD. A review of the trials comparing carotid endarterectomy and carotid angioplasty and stenting. Perspect Vasc Surg Endovasc Ther. 2008;20:299–308.

    Article  PubMed  Google Scholar 

  94. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352:1305–1316.

    Article  PubMed  CAS  Google Scholar 

  95. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994;154:1449–1457.

    Article  Google Scholar 

  96. Stroke Prevention in Atrial Fibrillation Investigators. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet. 1994;343:687–691.

    Google Scholar 

  97. Healey JS, Hart RG, Pogue J, et al. Risks and benefits of oral anticoagulation compared with clopidogrel plus aspirin in patients with atrial fibrillation according to stroke risk: the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events (ACTIVE-W). Stroke. 2008;39:1482–1486.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA

    Aslam M. Khaja MD

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  1. Sterling Rock Falls Clinic, 101 E. Miller Road, Sterling, 61081, USA

    Peter P. Toth

  2. Brigham & Women's Hospital, Cardiovascular Division, Harvard Medical School, Longwood Ave. 350, Boston, 02115, USA

    Christopher P. Cannon

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Khaja, A.M. (2011). Diagnosis and Management of Ischemic Stroke. In: Toth, P., Cannon, C. (eds) Comprehensive Cardiovascular Medicine in the Primary Care Setting. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-963-5_19

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