Atherothrombosis
Ischemic Stroke

The Risk of Ischemic Stroke

There are approximately 5.5 million stroke survivors in the United States. 7 Each year, approximately 700,000 new or recurrent strokes occur, and 88% of these are ischemic. 4

An ischemic stroke occurs from arterial obstruction in the brain. 2 The obstruction usually occurs due to thrombus within a brain artery, typically in vessels damaged by atherosclerosis. This is called cerebral thrombotic stroke. An ischemic stroke may also be caused by an embolus that has formed in an artery outside the brain or in the heart, and later becomes lodged in a brain artery. This is called cerebral embolism.

  • Stroke is the third leading cause of death in the United States, resulting in more than 157,000 deaths in 2003. 7
  • Stroke is also a leading cause of disability, with approximately 700,000 strokes occurring each year. 4
  • Of the estimated 700,000 strokes reported each year, about 200,000 are recurrent attacks and 500,000 are first attacks. 4

Risk Factors for Ischemic Stroke

Risk factors for an ischemic stroke that can't be modified: 10

  • Increasing age (the chance of having a stroke more than doubles for each decade after 55)
  • Heredity (the risk of ischemic stroke is higher in people who have a family history of a stroke)
  • Gender (stroke is more common in men than in women, but over half of all deaths from stroke occur in women)
  • Prior stroke, transient ischemic attack (TIA), or heart attack

Risk factors for an ischemic stroke that can be modified: 8

  • High blood pressure (hypertension)
  • Cigarette smoking
  • Diabetes mellitus
  • Carotid or other artery disease
  • Arterial fibrillation
  • Other heart disease
  • Sickle cell disease (also called sickle cell anemia)
  • High blood cholesterol
  • Poor diet
  • Physical inactivity or obesity

Other, less well-documented risk factors for an ischemic stroke include: 8

  • Geographic location
  • Socioeconomic factors
  • Alcohol abuse
  • Drug abuse

The warning signs of a stroke include: 3

  • Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or confusion
  • Sudden, severe headache with no known cause

In the aftermath of a stroke, there is a high risk of serious long-term disability, along with increased risk of a recurrent stroke. 4 Fifteen to 30 percent of stroke survivors are permanently disabled. One study showed that among stroke survivors 65 years and older observed 6 months post-stroke, 50% experienced some hemiparesis, nearly one third were unable to walk without aid, and more than 25% were institutionalized in a nursing home. The risk of suffering a recurrent stroke is also elevated: among persons who survive a first stroke or transient ischemic attack (TIA), 14 percent will have another within one year.

After ischemic stroke, the increased risk remains.* 16

Post ischemic stroke risk of myocardial infarction (MI) and stroke (risk chart)

Relevant Study — The REACH Registry


The REduction of Atherothrombosis for Continued Health — or REACH — Registry conducted a study of more than 69,000 patients, to identify comparable patterns in atherosclerosis risk factor prevalence. Read about the REACH Registry study.
Indications
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Use PLAVIX plus aspirin for patients with non–ST–segment elevation acute coronary syndrome (UA/non–Q–wave MI), including patients to be managed medically and those to be managed with percutaneous coronary intervention (with or without stent) or CABG, to decrease the rate of a combined end point of CV death, MI, or stroke as well as the rate of a combined end point of CV death, MI, stroke, or refractory ischemia.

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Use PLAVIX plus aspirin for patients with ST–segment elevation acute myocardial infarction to reduce the rate of death from any cause and the rate of a combined end point of death, reinfarction, or stroke. This benefit is not known to pertain to patients who receive primary angioplasty.

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Use PLAVIX alone for patients with a history of recent stroke, recent MI, or established PAD to reduce the rate of a combined end point of new ischemic stroke (fatal or not), new MI (fatal or not), and other vascular death.
Important Risk Information 18
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PLAVIX is contraindicated in patients with active pathologic bleeding such as peptic ulcer or intracranial hemorrhage. PLAVIX should be used with caution in patients who may be at risk of increased bleeding from trauma, surgery, or coadministration with NSAIDs or warfarin. (See CONTRAINDICATIONS and PRECAUTIONS.*)

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The rates of major and minor bleeding were higher in patients treated with PLAVIX plus aspirin compared with placebo
plus aspirin in clinical trials. (See ADVERSE REACTIONS.*)

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As part of the worldwide post–marketing experience with PLAVIX, there have been cases of reported thrombotic thrombocytopenic purpura (TTP), some with fatal outcome. TTP has been reported rarely following use of PLAVIX, sometimes after a short exposure (<2 weeks). TTP is a serious condition that can be fatal and requires urgent treatment including plasmapheresis (plasma exchange). (See WARNINGS.*)

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In clinical trials, the most common clinically important side effects were pruritus, purpura, diarrhea, and rash; infrequent events included intracranial hemorrhage (0.4%) and severe neutropenia (0.05%). (See ADVERSE REACTIONS.*)