Intended for healthcare professionals

Clinical Review

Post-acute care and secondary prevention after ischaemic stroke

BMJ 2011; 342 doi: (Published 08 April 2011) Cite this as: BMJ 2011;342:d2083
  1. K S McArthur, clinical research fellow1,
  2. T J Quinn, lecturer in geriatric medicine1,
  3. P Higgins, clinical research fellow1,
  4. P Langhorne, professor of stroke care1
  1. 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Western Infirmary, Glasgow G11 6NT, UK
  1. Correspondence to: K S McArthur kate.mcarthur{at}

Summary points

  • The management of stroke patients within dedicated stroke units prevents disability and saves lives for patients of all ages, with all types and severities of stroke

  • Venous thromboembolism prophylaxis with compression stockings is not routinely recommended and may cause harm.

  • Early mobilisation and physiotherapy are recommended by guidelines and appear to be safe, although definitive data on efficacy are awaited

  • Medical complications after stroke are common and affect functional outcomes as well as mortality; infection, delirium, and dysphagia are potentially treatable

  • Early artificial feeding with percutaneous gastrostomy tube has not shown longer term benefit for stroke survivors with impaired swallow and nasogastric feeding is recommended for initial management

  • Secondary prevention with anti-hypertensive, anti-thrombotic, and lipid lowering drugs reduces likelihood of recurrent stroke

In the first part of this two part review (BMJ 2011;342:d1938) we discussed acute diagnosis and management of cerebrovascular events. Much of the focus of recent research, public health initiatives, and health policy has been around acute and hyperacute management of stroke. However, important goals of stroke care are to maximise functional recovery and prevent recurrent events. Here we draw on evidence from randomised trials and meta-analyses to discuss models of care, rehabilitation, and secondary prevention in stroke.

An important aspect of post-acute stroke care is rehabilitation. Rehabilitation research remains a “young” science, although an evidence base is emerging. As we make progress in this field, we need a common language to describe this important intervention. In the box we offer our own definition of stroke rehabilitation, although others may offer differing suggestions. Many questions remain unanswered regarding timing, optimal components, and frequency and intensity of rehabilitation. Further discussion of rehabilitation as a concept or rehabilitation theory specific to stroke is beyond the scope of this article, but recent high quality publications on the subject are available.w1 …

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