L'ordonnance de sortie après ischémie cérébrale

Stroke is a major public health issue: it affects 120 000 people in France each year. The yearly recurrence rate is thought to reach 8 percent. Secondary prevention of stroke is thus crucial and focuses on controlling vascular risk factors most often associated with antiplatelet agents. Therapeutic objectives are set depending on the individual's global cardiovascular risk. The PROGRESS study has shown the relevance of systematic blood pressure lowering using an angiotensin-converting-enzyme inhibitor (perindopril) in combination with a diuretic (indapamide) in secondary prevention of stroke, including in normotensive patients. If possible, blood pressure should be below 130/85 mmHg. Statins are indicated in stroke patients with hypercholesterolemia, coronary heart disease, diabetes mellitus or carotid stenosis, the target LDL-cholesterol level being below 1 g/L (2.58 mmol/L). There is a wide consensus on treating patients with symptomatic carotid stenoses ≥70 percent by thrombo-endarterectomy and stroke associated with atrial fibrillation by anticoagulants. Management should be global and include changes in dietary behavior, tobacco and/or alcohol withdrawal, and regular exercising. Patient-specific therapeutic education should be offered in order to improve compliance.