Pregnant women with
stroke or transient ischemic attack may be considered for
treatment with unfractionated or low molecular weight heparin
throughout the first trimester, followed by low-dose ASA for
the remainder of the pregnancy, if a high-risk thromboembolic
condition is ruled out.65 In ischemic stroke of undetermined
origin, antiplatelet drugs are recommended as the first-line
treatment, and anticoagulants can be used when strokes
recur despite treatment with antiplatelet drugs. One of the
main problems in secondary stroke prevention is long-term
use of secondary prevention medications following stroke,
because up to one third of stroke patients discontinued one or
more such medications within 1 year of hospital discharge.66
Leistner et al compared the quality of secondary prevention
consisting of usual care versus a stepwise modeled support
program (outpatient appointments with a combination of
educational and behavioral strategies)67 and found that control
of risk factors remains unsatisfactory in usual care and a
support program leads to major improvement of secondary
prevention.