All the following have been shown to reduce the risk of atherothrombotic stroke in primary or secondary prevention EXCEPT:
Correct Answer: Warfarin
Description: Numerous studies have identified key risk factors for ischemic stroke. Old age, family history, diabetes, hypertension, tobacco smoking, and cholesterol are all risk factors for atherosclerosis and therefore stroke. Hypertension is the most significant among these risk factors. All cases of hypertension must be controlled in the setting of stroke prevention. Antiplatelet therapy has been shown to reduce the risk of vascular atherothrombotic events. The overall relative risk reduction of nonfatal stroke is about 25 to 30% across most large clinical trials. The “true” absolute benefit is dependent on the individual patient’s risk; therefore, patients with a low risk for stroke (e.g., younger, with minimal cardiovascular risk factors) may have a relative risk reduction with antiplatelet therapy but a meaningless “benefit.” Numerous studies have shown the benefit of statin therapy in the reduction of stroke risk even in the absence of hypercholesterolemia. Although anticoagulation is the treatment of choice for atrial fibrillation and cardioembolic causes of stroke, there is no proven benefit in regard to the prevention of atherothrombotic stroke; therefore, warfarin cannot be recommended.
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