Perioperative management of adult patients with a history of stroke or transient ischaemic attack undergoing elective non-cardiac surgery

It is increasingly common for physicians and anaesthetists to
be asked for advice in the medical management of surgical
patients who have an incidental history of stroke or transient
ischaemic attack (TIA). Advising clinicians requires an understanding
of the common predictors, outcomes and management
of perioperative stroke. The most important predictor
of perioperative stroke is a previous history of stroke, and outcomes
associated with such an event are extremely poor. The
perioperative management of this patient group needs careful
consideration to minimise the thrombotic risk and a comprehensive,
individualised approach is crucial. Although there is
literature supporting the management of such patients undergoing
cardiac surgery, evidence is lacking in the setting of noncardiac
surgical intervention. This article reviews the current
evidence and provides a pragmatic interpretation to inform
the perioperative management of patients with a history of
stroke and/or TIA presenting for elective non-cardiac surgery.