First, blood pressure management.
Blood pressure should be monitored regularly, and those with a history of hypertension should receive cerebrovascular assessment. Generally, the blood pressure should be controlled below 140/90mmHg, and the blood pressure should be controlled reasonably according to whether there are cerebrovascular diseases such as cerebrovascular stenosis or aneurysm. For patients whose blood pressure is higher than the target, antihypertensive drugs should be used as soon as possible to make their blood pressure reach the standard.
Second, blood sugar management.
People with a history of stroke //TIA or high risk of stroke should be screened for diabetes, and it is suggested that fasting blood glucose should be tested regularly, and oral glucose tolerance test or glycosylated hemoglobin should be done if necessary. Diabetic patients should change their lifestyle, control their diet and strengthen physical exercise. Those who are still not satisfied with blood sugar control after 2~3 months can choose oral hypoglycemic drugs or insulin treatment. The blood sugar control target of diabetic patients is 7% glycosylated hemoglobin, but it must follow the principle of individualization. For young patients with short course of disease and no complications, glycosylated hemoglobin should be as close to the normal level as possible under the premise of avoiding hypoglycemia; For the elderly, patients with severe or frequent hypoglycemia and serious complications, the control target can be relaxed appropriately.
Third, blood lipid management.
Check blood lipids regularly at all ages, and determine the target value of blood lipid control according to the risk stratification of abnormal people. First, change the lifestyle, and those who fail will receive medication. Drug selection should be based on the patient's blood lipid level and classification of dyslipidemia.
Patients with ischemic stroke //TIA with dyslipidemia should be treated with lifestyle intervention and medication. According to the risk stratification, the target value of low density lipoprotein cholesterol (LDL-C) is 1.8mmol/L or at least reduced by 50% for patients with multiple risk factors and evidence of intracranial and extracranial atherosclerotic vulnerable plaque or arterial embolism. Before and during statin treatment, we should pay attention to whether there are clinical symptoms such as myalgia, and monitor the changes of liver enzymes and muscle enzymes. For people with a history of cerebral hemorrhage or high risk of cerebral hemorrhage, we should weigh the risks and benefits and use statins with caution.
1. It is suggested that patients with high risk of stroke (according to Framingham scale 10% risk of cardiovascular and cerebrovascular events) should use aspirin individually for primary prevention.
2. Scientific risk stratification and stratified management (Essen score or ABCD score) should be strengthened in the secondary prevention of patients with non-cardiogenic ischemic stroke //TIA. Except for a few cases requiring anticoagulant therapy, antiplatelet drugs are recommended in most cases. The choice of antiplatelet drugs is mainly monotherapy, and aspirin and clopidogrel can be the first choice. The combination of aspirin and clopidogrel is recommended for patients with acute coronary artery disease or recent stent implantation.
3. Patients with hypertension should pay attention to the risk of cerebral hemorrhage after long-term use of aspirin, and then use aspirin after blood pressure control is stable (150/90mmHg).
Five, anticoagulant therapy
1. For patients with atrial fibrillation without hemorrhagic stroke //TIA, according to the risk stratification, bleeding risk assessment and patients' wishes, combined with whether the local hospital has anticoagulant monitoring conditions, decide whether to carry out anticoagulant therapy. If there are indications of anticoagulation, routine anticoagulation therapy should be performed. The use of warfarin needs to monitor the international normalized ratio (INR), and the new generation of anticoagulant Saban has the advantage of not monitoring INR.
2. For patients with ischemic stroke //TIA who have a history of paroxysmal or persistent atrial fibrillation, warfarin is suggested to be anticoagulated to prevent the recurrence of thromboembolism; For patients with non-cardiogenic ischemic stroke //TIA, anticoagulant therapy can be considered in some special cases, such as aortic arch atherosclerotic plaque, basilar artery spindle aneurysm, carotid dissection, patent foramen ovale deep vein thrombosis or atrial septal aneurysm.
3. For patients with cerebral venous thrombosis, if there are no contraindications, anticoagulant therapy should be carried out as soon as possible.
Six, Chinese medicine treatment
Traditional Chinese medicine treatment emphasizes the principle of syndrome differentiation and treatment, and adopts prescriptions according to the dynamic changes of syndromes in each stage of stroke course.