Secondary prevention in stroke: a primary rehabilitation concern.

Stroke is a recurrent disease. Approximately one in four hospital admissions for stroke is due to recurrence; patients who have had a stroke are five times as likely to have another stroke as matched controls without stroke. While attention has been focused on the problem of primary prevention of stroke in patients with hypertension and/or transient ischemic attacks, the important problem of preventing stroke recurrence has been addressed to only a limited extent. In this paper, we review known risk factors for recurrence as well as possible medical and surgical approaches to reducing the probability of stroke recurrence. At this point, there appears to be no intervention which has unequivocal proven benefit, although several large-scale clinical trials are now in progress. Further clinical research on this problem is needed. An opportune time to institute and conduct research on interventions directed toward reducing the risk of stroke recurrence may be during the subacute recovery phase while patients are engaged in a program of comprehensive medical rehabilitation. Prevention of recurrent stroke and related vascular events for which stroke patients have increased risk (eg, myocardial infarction) should be of major concern in stroke rehabilitation practice.