Diabetes mellitus is the second major risk factor for
ischemic stroke. Recent increase in atherothrombotic
stroke appears to be related with recent increasing of diabetes. Diabetes is, however, a risk factor not only for atherothrombotic
stroke but also for
lacunar stroke because there is no difference in prevalence of diabetes between atherothrombotic and
lacunar strokes. Diabetes can be a risk factor for
cardioembolic stroke as well because the major cause of
cardioembolic stroke is
atrial fibrillation, and diabetes is a risk factor for
stroke in patients with
atrial fibrillation.
Acute ischemic stroke should be classified into above three subtypes according to the brain and artery imaging as well as cardiac sources of
embolism. In hyper-acute patients within 3 hours of onset and without early ischemic signs on CT or ischemic lesions less than one third of the hemisphere on magnetic resonance diffusion-weighted imaging,
thrombolytic therapy with
alteplase is indicated. In
acute stroke patients later than 3 hours of onset,
argatroban,
heparin, and
ozagrel are indicated for atherothrombotic, cardioembolic, and
lacunar stroke, respectively. For
stroke prevention, total management is required by simultaneous treatments for all risk factors existed. In
secondary prevention for
stroke, in addition to the more strict control of risk factors antithrombotic
therapy is required, that is, antiplatelet
therapy is indicated for non-
cardioembolic stroke, and
anticoagulant therapy is indicated for
cardioembolic stroke.