From the Guidelines
The probability of stroke recurrence is approximately 5% within 90 days after a first stroke, but can vary greatly from >10% to <1% depending on the stroke mechanism, with symptomatic carotid stenosis and atrial fibrillation being important factors to diagnose and treat in a timely fashion. The modified Rankin Scale (mRS) scores, which measure the degree of disability following a stroke, can also impact the risk of recurrent stroke. Patients with higher mRS scores (3-5, moderate to severe disability) may have a higher risk of recurrent stroke compared to those with lower mRS scores (0-2, no or minor disability) due to factors such as more extensive underlying vascular disease, difficulty adhering to medication regimens, and more comorbidities that increase stroke risk 1. To reduce recurrence risk, patients should adhere to individualized secondary prevention strategies, including:
- Antiplatelet therapy, such as aspirin 81-325mg daily or clopidogrel 75mg daily
- Statins, typically high-intensity like atorvastatin 40-80mg or rosuvastatin 20-40mg daily
- Blood pressure control, with a target of <130/80 mmHg
- Anticoagulation for atrial fibrillation, using DOACs like apixaban 5mg twice daily or warfarin with INR 2-3 Additionally, lifestyle modifications, including smoking cessation, limited alcohol intake, regular physical activity within capability, and dietary improvements, are essential regardless of mRS score 1. Regular follow-up with healthcare providers to monitor and adjust these interventions is crucial, particularly for those with higher disability levels who face greater recurrence risks.
From the Research
Probability of Stroke Recurrence According to the Modified Rankin Scale
- The modified Rankin Scale (mRS) is used to quantify disability following stroke, and its usefulness as a determinant of long-term outcome has been studied 2.
- Research has shown that patients with worse mRS scores have a significant excess risk of death, and this effect persists even when controlling for coexistent cardiovascular problems 2.
- A study found that the mRS score is a predictor of functional recovery in ischemic stroke patients, with independent variables such as leg score, arm score, and age older than 75 years affecting functional recovery 3.
- The simplified modified Rankin scale questionnaire (smRSq) has been validated as a reliable and useful alternative measure of functional status after acute ischemic stroke, with good agreement with the standard mRS 4.
- Repeated measures of mRS scores have been used to assess functional recovery from stroke, and associations with functional recovery have been identified, including age at stroke, prestroke history, and stroke treatment 5.
- The mRS, along with the National Institutes of Health Stroke Scale (NIHSS) and the modified Thrombolysis in Cerebral Infarction (mTICI), has been found to be a predictive tool of functionality in stroke patients, especially in the acute phase 6.
Key Findings
- The mRS score is a significant predictor of long-term outcome and functional recovery in stroke patients.
- Patients with worse mRS scores have a higher risk of death and poor functional recovery.
- The smRSq is a reliable and useful alternative measure of functional status after acute ischemic stroke.
- Repeated measures of mRS scores can improve trial precision in identifying trial associations and effects.
- The mRS, NIHSS, and mTICI are predictive tools of functionality in stroke patients, especially in the acute phase.
Predictive Factors
- Age at stroke
- Prestroke history (e.g. diabetes, coronary heart disease, ischemic stroke)
- Stroke treatment (e.g. ischemic stroke, hemorrhagic stroke)
- Baseline National Institutes of Health Stroke Scale (NIHSS) scores
- Patient Health Questionnaire-9 (PHQ-9) scores
- Leg score and arm score 3