The emergency department: first line of defense in preventing secondary stroke.

Stroke and transient ischemic attack (TIA) are increasingly common conditions that are associated with significant morbidity and mortality. The strongest predictor of recurrent stroke risk is an initial stroke or TIA; in fact, nearly 30% of all strokes are recurrent events. It is often the emergency department (ED) physician who, while treating the initial event, has the first opportunity to initiate effective preventive strategies, including pharmacotherapy and behavior modification. Evidence- and consensus-based guidelines are well established for the use of antiplatelet medications, anticoagulants, and antihypertensives for prevention of secondary stroke. Recent evidence suggests that the use of statins may be associated with improved clinical outcomes after ischemic stroke. In addition, behavioral interventions, such as smoking cessation, exercise, diet, and stroke education, can help patients avoid stroke recurrence. By initiating prevention therapies during the acute stroke or TIA encounter, EPs convey the message to patients that these therapies are important for the prevention of recurrent events and are an essential part of the treatment.