First-Ever Guidelines Issued on Stroke Prevention in Women

February 6th, 2014

First-Ever Guidelines Issued on Stroke Prevention in Women

Nicholas Downing, MD

The American Heart Association and American Stroke Association have issued the first stroke-prevention guidelines that focus on women’s unique risks.

Among the recommendations:

Pregnant women with chronic hypertension or a history of pregnancy-related hypertension should take low-dose aspirin, beginning at 12 weeks’ gestation, to reduce pre-eclampsia risk.

Preeclampsia is a risk factor for stroke later in life, and other risk factors in such women should be treated early.

Pregnant women with severe hypertension should receive antihypertensive therapy (e.g., methyldopa, labetalol); those with moderate hypertension (150-159 mm Hg/100-109 mm Hg) may be considered for treatment.

Suspicion of cerebral venous thrombosis, more common in women, should warrant routine blood studies: complete blood count, chemistry panel, prothrombin time, and activated partial thromboplastin time.

Hooman Kamel, a neurologist with NEJM Journal Watch, notes that, “Certain stroke risk factors are unique to women or occur more commonly in women. To help better address these gender-specific risk factors, the American Heart Association/American Stroke Association have just released a first-ever set of guidelines for the prevention of stroke in women. To be effective, many of these recommendations will require diffusion into routine primary care practice: for example, pulse screening for atrial fibrillation, or flagging patients with pre-eclampsia or eclampsia for close monitoring of blood pressure after pregnancy. Other recommendations provide a practical guide for stroke specialists: for example, guidelines on the evaluation and treatment of cerebral venous thrombosis, which occurs much more commonly in women. It is to be hoped that more tailored treatment of these gender-specific risk factors will ultimately reduce the overall burden of stroke.”

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February 6th, 2014