First-Ever Guidelines Issued on Stroke Prevention in Women — Physician’s First Watch

Medical News |
February 7, 2014

First-Ever Guidelines Issued on Stroke Prevention in Women

By Amy Orciari Herman

The American Heart Association and American Stroke Association have issued the first stroke-prevention guidelines that focus on women's unique risks.

Among the recommendations:

-- Pregnant women with chronic hypertension or a history of pregnancy-related hypertension should take low-dose aspirin, beginning at 12 weeks' gestation, to reduce preeclampsia risk.

-- Preeclampsia is a risk factor for stroke later in life, and other risk factors in such women should be treated early.

-- Pregnant women with severe hypertension should receive antihypertensive therapy (e.g., methyldopa, labetalol); those with moderate hypertension (150-159 mm Hg/100-109 mm Hg) may be considered for treatment.

-- Suspicion of cerebral venous thrombosis, more common in women, should warrant routine blood studies: complete blood count, chemistry panel, prothrombin time, and activated partial thromboplastin time.

Hooman Kamel, a neurologist with NEJM Journal Watch, notes that "to be effective, many of these recommendations will require diffusion into routine primary care practice."

Reader Comments (3)

Majid Nimrouzi, PhD. Candidate Physician, Other, School of Traditional Medicine, Tehran University of Medical Sciences

Stroke with a huge negative impact on society, more adversely affect women. There is scarce evidence about any neuroprotective effects of commonly used drug in acute stroke. [1] Bushnell et al provided a guideline focusing on the risk factors of stroke unique to women including reproductive factors, metabolic syndrome, obesity, atrial fibrillation and migraine with aura. [2] We believe that considering ten variables, cited by Avicenna in Canon of medicine, can cover some gaps mentioned in this guideline.
Avicenna noted ten variables should be considered before starting treatment. The prescribed drugs should be selected qualitatively opposite to mezaj (warm-cold and wet-dry qualities induced by disease state) of disease and according to ten variables, including the nature of the affected organ, intensity of disease, sex, age, habit, season, place of living, occupation, stamina and physical status. [3]
Avicenna believed that sakteh (stroke) happens because of a blockage in the rooh-e-nafsani (neural pathway) or in the cerebral blood vessels. Blockage may happen in sobat (carotid arteries) or in its cerebral branches. Sobat conveys sanguine and phlegm to the brain. The main energy source of the brain is phlegm. In abundance of phlegm, especially in susceptible individuals, the brain cannot metabolize it completely and blockage of vessels occur. Increasing age, sex (female), sedentary lifestyle, a'araz-e-nafsani (stress), overeating and high calorie diet are considered as the main causes of stroke according to Canon of medicine. Avicenna confirmed that the treatment of stroke is very difficult and sometimes impossible. He recommended nasal application of aroma in acute phases of stroke. Avicenna considered fasd (bloodletting of cephalic vein) in hyperemic patients with hemorrhagic stroke. [3 4] Blood thinner drugs with warm-dry quality that evacuated the phlegm such as Zataria mltiflora boiss was considered helpful for stroke. [5]
1. Mc Govern R, Rudd A. Management of stroke. Postgraduate medical journal 2003;79(928):87-92
2. Bushnell C, McCullough LD, Awad IA, et al. Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2014 doi: 10.1161/01.str.0000442009.06663.48[published Online First: Epub Date]|.
3. Avicenna H. Ghanoon Dar Teb [The Canon of Medicine], Bulaq Edition. Sharafkandi A, trans. Tehran: Univ of Tehran Pr 1978
4. Zargaran A, Zarshenas MM, Karimi A, Yarmohammadi H, Borhani-Haghighi A. Management of Stroke Described by Ibn Sina (Avicenna) in the Canon of Medicine. International Journal of Cardiology (0) doi:[published Online First: Epub Date]|.
5. Khorasani MA. Makhzan al Advieh: Bavardaran Press. Research institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran, 2001.

Lisa Halley RN CRN(c) stroke follow up nurse Other Healthcare Professional, Neurology, WRH Ouelette Campus Windsor Ontario District Stroke Center

This was interesting is there a full article I could read on this?

Dana Killam,M.D. Physician, Emergency Medicine, Accident and Urgent Care Center

Risk factors as smoking , hormonal therapy, previous Hx. TIA's /Stroke . hypercoagulable status, autoimmune diseases,etc .are those if uncorrectible ,then pregnancy should be discouraged. The patient when pregnant,then should be closely managed by the 'high risk' specialists

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