A 73-year-old man presents with a right hemiparesis and expressive dysphasia secondary to an infarct in the territory of the left middle cerebral artery. Blood pressure is 153/82 mmHg, serum cholesterol is 4.4 mmol/L and the ECG shows sinus rhythm with no abnormalities. Which of the following medications is least likely to be of benefit in preventing a further ischaemic stroke?
- Ramipril
- Bendroflumethiazide
- Aspirin
- Warfarin
- Simvastatin
In addition to lifestyle modifications, antiplatelet, lipid-lowering and antihypertensive therapy forms the cornerstone of secondary prevention for most patients with an ischaemic stroke. Recent large-scale randomised trials have demonstrated the benefit of statins and antihypertensives in these patients, even with blood pressure and cholesterol levels within the ‘normal’ range. Patients in atrial fibrillation benefit from anticoagulation with warfarin following ischaemic stroke, but there is no such benefit in those who are in sinus rhythm. The evidence base for stroke secondary prevention is included in the book, as below.
More on Secondary prevention of stroke (p. 1188)
More on Secondary prevention of stroke (p. 1188)
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