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Recurrent Ischemic Stroke: Prevention Strategies

Brian Ford, MD
Michael M. Dore, MD
Tyler R. Koehn, MD

American Family Physician. 2026;113(1):57-69.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Ischemic strokes account for 87% of acute strokes, and 12% of patients with acute ischemic stroke have recurrence within 5 years. After an acute ischemic stroke is identified, several tools can be used to help detect the likely cause. Controlling cardiovascular risk factors with antihypertensive therapy (with a goal of 130/80 mm Hg), statin therapy, blood glucose control, healthy diet, regular exercise, avoidance of substance use, treatment of obstructive sleep apnea, if present, and care based on the cause of stroke reduces the risk of recurrence. Antithrombotic therapy with anticoagulants is recommended for embolic stroke due to atrial fibrillation; antiplatelet therapy is more commonly used for the treatment of nonembolic stroke. Procedural management for those with carotid stenosis or closure of patent foramen ovale may be indicated. Additional evaluation, such as long-term cardiac monitoring to identify initially undetected atrial fibrillation, may be required if the cause of stroke is unclear.

BRIAN FORD, MD, FAAFP, is an associate professor in the Department of Family Medicine at Uniformed Services University of the Health Sciences, Bethesda, Maryland.

MICHAEL M. DORE, MD, FACP, is an associate professor in the Department of Medicine at Duke University Medical Center, Durham, North Carolina.

TYLER R. KOEHN, MD, is a vascular neurologist in the Department of Neurology at Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas.

Address correspondence to Brian Ford, MD, FAAFP, at bford1@gmail.com.

Author disclosure: No relevant financial relationships.

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