What secondary prevention strategies should be implemented for a patient who has recently experienced an ischaemic stroke?

Secondary prevention strategies for a patient who has recently experienced an ischemic stroke include:

• Initiate antiplatelet therapy, typically clopidogrel 75 mg daily, or aspirin 75 mg daily with modified-release dipyridamole 200 mg twice daily if clopidogrel is not tolerated. Aspirin 300 mg daily may be used initially in the interim period ¹.
• Consider dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel for 21 days in patients with non-cardioembolic minor ischemic stroke or high-risk TIA, ideally started within 12–24 hours of symptom onset ¹.
• Start high-intensity statin therapy, such as atorvastatin 80 mg daily, to reduce lipid levels and prevent recurrent vascular events ¹.
• Manage vascular risk factors aggressively, including controlling hypertension to targets recommended by NICE Hypertension guidelines, and optimizing glycaemic control in diabetics aiming for HbA1c ≤7% where appropriate ¹.
• Screen for and treat obstructive sleep apnoea with CPAP if present ¹.
• Advise lifestyle modifications: encourage daily physical activity, smoking cessation, a healthy balanced diet low in saturated fats and salt, and limit alcohol intake to within recommended limits (14 units per week) ¹.
• Review and support medication adherence and provide patient and carer education about stroke, secondary prevention, and lifestyle ¹,³.
• Do not routinely use vitamin or mineral supplements (e.g., folate, vitamins B6, B12, A, C, E, calcium, selenium) for secondary stroke prevention ¹.
• Arrange follow-up in primary care at 6 months post-discharge and then annually to review health, social care needs, risk factors, and secondary prevention measures ¹.