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:

• Antiplatelet therapy: Initiate long-term antiplatelet treatment, typically clopidogrel 75 mg daily, or aspirin 75 mg daily with modified-release dipyridamole 200 mg twice daily if clopidogrel is not tolerated. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel or aspirin and ticagrelor may be used short-term (21 to 30 days) in selected patients with minor non-cardioembolic ischemic stroke or high-risk TIA to reduce recurrence risk, followed by monotherapy.
• Statin therapy: Start high-intensity statin therapy, such as atorvastatin 80 mg daily, to reduce lipid levels and vascular event risk, unless contraindicated or risk of adverse effects is high.
• Blood pressure control: Manage blood pressure according to NICE hypertension guidelines, aiming for targets similar to those for cardiovascular disease prevention.
• Management of comorbidities: Optimize control of diabetes with individualized HbA1c targets (generally ≤7%), treat obstructive sleep apnea with CPAP if present, and manage other vascular risk factors.
• Lifestyle advice: Encourage daily physical activity, smoking cessation, a healthy balanced diet (including at least five portions of fruit and vegetables daily and two portions of oily fish weekly), and limit alcohol intake to within recommended limits (14 units per week).
• Patient education and support: Provide verbal and written information about stroke, secondary prevention medications, lifestyle changes, and support for social care needs, including advice on driving and returning to work.

Routine supplementation with vitamins (B, C, E), folate, or minerals is not recommended for secondary stroke prevention.