What percentage of stroke survivors experience a second stroke within the first year?

Recurrent Stroke Risk in the First Year After Initial Stroke

Approximately 5.1% of stroke survivors experience a second stroke within the first year after their initial stroke. 1

Risk of Recurrent Stroke in the First Year

The risk of recurrent stroke is highest in the early period following an initial stroke:

• The 1-year cumulative risk of recurrent stroke is approximately 5.1% according to the most recent data from the TIA Registry.Org group 1
• This represents a significant reduction from historical rates of 12-20% due to improved prevention strategies and rapid-access TIA clinics 1
• The risk is particularly concentrated in the early post-stroke period:
  • Day 2: 1.5% recurrence risk 1
  • Day 7: 2.1% recurrence risk 1
  • Day 30: 2.8% recurrence risk 1
  • Day 90: 3.7% recurrence risk 1

Factors Influencing Recurrence Risk

Several factors can influence the risk of recurrent stroke:

• Presence of multiple vascular risk factors can increase the 7-day stroke risk following TIA to as high as 36% 1
• Hypertension is a major modifiable risk factor, with approximately 70% of stroke survivors having premorbid hypertension 1
• Rapid evaluation and treatment through specialized TIA clinics has been shown to significantly reduce recurrence rates 1
• The implementation of comprehensive prevention strategies including antiplatelets, anticoagulants, antihypertensives, and lipid-lowering agents has contributed to the reduction in recurrence rates 1

Mortality and Outcomes of Recurrent Stroke

Recurrent strokes carry a higher mortality risk compared to initial strokes:

• The case mortality rate is 41% after a recurrent stroke versus 22% after an initial stroke 1
• This highlights the critical importance of effective secondary prevention strategies 1

Prevention Strategies

Secondary prevention is crucial and should be implemented promptly:

• Antihypertensive treatment should be restarted after the first few days of the index event 1
• Specific medications that have shown benefit include:
  • Thiazide diuretics 1
  • ACE inhibitors 1
  • ARBs 1
  • Combination therapy with a thiazide diuretic plus ACE inhibitor 1
• Blood pressure goals of less than 130/80 mm Hg may be reasonable for secondary stroke prevention 1
• Other preventive measures include antiplatelet therapy, lipid management, and lifestyle modifications 1

Long-Term Risk Perspective

While this question focuses on the first year, it's worth noting:

• After the first year, the average annual risk of recurrent stroke stabilizes at approximately 4% 1, 2
• This remains about 4-6 times higher than the risk of first-ever stroke in the general population of the same age and sex 3, 2
• The cumulative risk of recurrent stroke increases to approximately 22.5% by 5 years 4 and 43% by 10 years 2

Clinical Implications

The evidence underscores the importance of:

• Rapid evaluation and treatment of TIA and stroke 1
• Aggressive management of modifiable risk factors 1
• Long-term adherence to preventive medications 1
• Regular follow-up to monitor and adjust prevention strategies 1