Subtype diagnosis and antithrombotic therapy for patients with recurrent cerebral infarction and identification of the cause of recurrence: a retrospective analysis

• Published in: Japanese Journal of Stroke Vol. 43; no. 2; pp. 124 - 131
• Main Authors: Yamamoto, Kanji, Tazawa, Ko-ichi, Kondo, Yasufumi, Kusano, Yoshikazu
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2021
• Subjects: recurrent cerebral infarction; secondary prevention; stroke subtype diagnosis
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.10808

Background and Purpose: Cerebral infarction recurrence is frequent and leads to deterioration in a patient’s physical performance. This retrospective analysis was conducted to build up hypotheses about secondary prevention in patients with cerebral infarction. Methods: We investigated patients with recurrent cerebral infarction and a history of acute cerebral infarction. The first stroke was re-diagnosed with examination data in the events of recurrent stroke, and this re-diagnosis was referred as the initial diagnosis. Subtype diagnosis of recurrent stroke was compared with the initial diagnosis and re-diagnosis of the first stroke. Furthermore, the main cause of recurrent stroke was individually assessed. Results: We extracted 172 events of recurrent cerebral infarction in 154 patients from 6 years of our hospital’s medical records. Excluding patients diagnosed by different criteria, the re-diagnosis was different from the initial diagnosis in 27 patients (17.5%). Different antithrombotic medications should be selected between the first and recurrent strokes by initial diagnosis in 16 patients and by re-diagnosis in 9 patients. The presumed causes of recurrence included 31 events (18.0%) by correctable causes, such as nonadherence of medication, disuse of or withdrawal from antithrombotic therapy for unknown reasons, insufficiency of administered warfarin, and inappropriate selection of antithrombotic medication due to misdiagnosis of the first stroke subtype. Conclusion: The subtype of the first cerebral infarction was occasionally misdiagnosed. A careful diagnosis of stroke, appropriate selection of antithrombotic medication, and intensive patient education should be paid close and continuous attention to prevent recurrence of cerebral infarction.