It’s long been known that your risk for a stroke is increased during the month after a heart attack. But after that, it was thought, your stroke risk returns to normal. However, one month is too soon to relax your stroke watch, according to the latest research.

Because a heart attack (myocardial infarction) interrupts normal blood circulation, it’s easy for a blood clot to be released into the bloodstream, which then can travel to the brain and cause an ischemic stroke. Studies have found that this risk is highest in the first month after a heart attack. However, those studies were done on small numbers of patients.

To get a more detailed picture of post–heart attack stroke risk, researchers at Weill Cornell Medical College looked at data from 1.7 million people on Medicare over a period of about 4.6 years, including more than 46,000 patients over age 65 who were hospitalized after a heart attack.

Results: As expected, risk for stroke was almost three times higher than normal risk in the first month after a heart attack. However, stroke risk was doubled during the second month…and was still elevated during the third month (about 60% higher). Risk did not return to normal until after the third month.

The researchers surmise that increased stroke risk is partly the result of decreased heart function post–heart attack, during which time the heart is not beating efficiently, and blood tends to pool and form clots. For this reason, heart attack patients typically are prescribed a blood thinner, such as aspirin, after a heart attack. These new findings suggest that patients may need to take a more powerful anticoagulant…and possibly for longer. The researchers suggest that more research is needed to develop guidelines.

Meanwhile, if you or a loved one has recently had a heart attack, alert your doctor that your stroke risk may be higher than previously thought—and discuss strategies to reduce risk. And stay alert for the “F.A.S.T.” warning signs of stroke: Face drooping…Arm weakness…Speech difficulty…and Time to call 911.

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