8
Treatment
Table 19. Hyperhomocysteinemia
Recommendations
COR LOE
e use of the B complex vitamins, cobalamin (B
12
), pyridoxine (B
6
),
and folic acid might be considered for the prevention of ischemic
stroke in patients with hyperhomocysteinemia, but its effectiveness is
not well established.
IIb B
Table 20. Elevated Lp(a)
Recommendations
COR LOE
e use of niacin, which lowers Lp(a), might be reasonable for the
prevention of ischemic stroke in patients with high Lp(a), but its
effectiveness is not well established.
IIb B
e clinical benefit of using Lp(a) in stroke risk prediction is not well
established.
IIb B
Table 21. Hypercoagulability
Recommendations
COR LOE
e usefulness of genetic screening to detect inherited
hypercoagulable states for the prevention of first stroke is not well
established.
IIb C
e usefulness of specific treatments for primary stroke
prevention in asymptomatic patients with a hereditary or acquired
thrombophilia is not well established.
IIb C
Low-dose aspirin (81 mg/d) is NOT indicated for primary stroke
prevention in individuals who are persistently aPL positive.
III B
Table 22. Inflammation and Infection
Recommendations
COR LOE
Patients with chronic inflammatory disease such as RA or SLE should
be considered at increased risk of stroke.
I B
Annual influenza vaccination can be useful in lowering stroke risk in
patients at risk of stroke.
IIa B
Measurement of inflammatory markers such as hs-CRP or
lipoprotein-associated phospholipase A2 in patients without CVD
may be considered to identify patients who may be at increased risk
of stroke, although their usefulness in routine clinical practice is not
well established.
IIb B
Treatment of patients with hs-CRP >2.0 mg/dL with a statin to
decrease stroke risk might be considered.
IIb B
Treatment with antibiotics for chronic infections as a means to
prevent stroke is NOT recommended.
III A
