Recommendations from NICE include:

• clopidogrel is now recommended by NICE ahead of combination use of aspirin plus modified-release (MR) dipyridamole in people who have had an ischaemic stroke
• aspirin is recommended after an ischaemic stroke only if clopidogrel is contraindicated or not tolerated

Carotid endarterectomy is recommend if the patient has suffered a stroke or TIA in the carotid territory and is not severely disabled

• should only be considered if the stenosis > 50% according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria
• it should be noted that previous guidelines have used other reporting methods, that have resulted in different cut-offs, e.g. European Carotid Surgery Trial (ECST) with a cut-off of 70%
• it should be performed as soon as possible within 7 days

Atrial fibrillation is one of the key risk factors for ischaemic stroke. It is therefore very important to recognise and treat atrial fibrillation if it's identified in a patient following a stroke or transient ischaemic attack (TIA).

Management

• following a stroke or TIA it is obviously important to exclude a haemorrhage before starting any anticoagulation or antiplatelet therapy
• for longer-term stroke prevention, NICE recommend warfarin or a direct thrombin or factor Xa inhibitor
• the timing of when to start depends on whether it is a TIA or stroke
  • following a TIA, anticoagulation for AF should start immediately once imaging has excluded haemorrhage
  • in acute stroke patients, in the absence of haemorrhage, anticoagulation therapy should be commenced after 2 weeks. Antiplatelet therapy should be given in the intervening period. If imaging shows a very large cerebral infarction then the initiation of anticoagulation should be delayed

Post-Stroke

Check Functional Disability Score (Barthel Index)