Can Stroke Happen Again? Why Finding the Cause Matters
Explained by a neurology physician, based on the latest guidelines and research
3,847 TIA and minor stroke patients
of all recurrent strokes
work-up for the cause completed or started
mmHg
Short answer: Yes, it can, and the risk does not end after the first year. A follow-up of nearly 4,000 TIA and minor stroke patients found that within 5 years, recurrent stroke occurred in 9.5% and 43% of these recurrences happened in years 2–5. Effective prevention is therefore not just taking all your medicines; you must know what caused the first stroke, because each cause is prevented differently. The AHA/ASA 2021 guideline recommends completing, or starting, the work-up for the cause within 48 hours of symptom onset.
This article provides general information. Each person's diagnosis and treatment must be assessed by a physician.
In this article
1. Why the risk remains even after symptoms improve
Short answer: Families are often relieved when the patient can walk again, but what caused the first stroke, such as narrowed arteries, an irregular heartbeat or high blood pressure, is mostly still in the body. If the cause is not managed, the risk remains.
A 5-year follow-up study (NEJM, 2018) found that major vascular events (stroke, heart attack or vascular death) occurred about as often in the first year as in years 2–5 combined. Care must therefore continue for years, not just in the period after leaving hospital.
And among patients with a recurrent stroke, dementia is found in more than 1 in 3, much higher than after a first stroke (read about memory after stroke)
Preventive medicines depend on the cause of the first stroke; never stop or change them yourself
2. 5 main causes, prevented differently
Short answer: This table applies to ischemic stroke (narrowed or blocked brain arteries) and TIA, which are the most common types. If it is hemorrhagic stroke (bleeding in the brain), the main prevention is blood pressure control, and some medicine groups in this table may be contraindicated; ask your doctor only.
| Cause | What it is | Main prevention (chosen by the doctor) |
|---|---|---|
| Large-artery narrowing | Fatty plaque in the neck arteries or brain arteries | Antiplatelets and cholesterol-lowering medicines; some patients need surgery or a stent in the neck artery |
| Small-vessel disease of the brain | Tiny arteries damaged by long-standing high blood pressure or diabetes | Mainly controlling blood pressure to target, together with antiplatelets |
| Clot from the heart | Mostly from atrial fibrillation (AF), which some people have without symptoms | Anticoagulants (a different group from antiplatelets) |
| Specific causes | Such as arterial dissection, blood-clotting disorders or a hole in the heart (PFO) in younger patients | Treated according to the cause, case by case |
| No cause found | Still unclear after complete testing | May need continuous ECG monitoring for days to weeks to find hidden AF |
A study in JAMA Neurology (2023) found that many patients have several causes at once, and the 5-year risk differs greatly by cause. This is why the same prevention package should not be used for everyone.
Each group of medicines targets a different cause; medicine sorting should be double-checked
3. Tests a stroke patient should have
Short answer: Check the hospital documents to see whether the patient has had these tests
- Brain imaging (CT or MRI) to identify the type and location of the stroke
- Imaging of the neck and brain arteries (ultrasound, CTA or MRA)
- An electrocardiogram, and continuous heart rhythm monitoring when the doctor considers it appropriate
- Heart ultrasound, when a clot from the heart is suspected
- Long-term blood sugar (HbA1c) and blood cholesterol
- Screening for sleep apnea if there is loud snoring or marked daytime sleepiness
If you are not sure whether all tests have been done, there is no need to repeat everything. Bring the hospital documents for a neurology physician to see what is still missing. Some tests, such as MRI or a heart ultrasound through the esophagus, still have to be done at a hospital.
4. Factors families can help control every day
- Blood pressure — the AHA/ASA 2021 guideline sets a target below 130/80 mmHg for most patients (for some, such as severe artery narrowing, the doctor may set a different target). Measure at home and keep a record for the doctor.
- Take medicines regularly; do not stop them yourself, even when symptoms have improved (read about medicines after stroke)
- Blood sugar and cholesterol to the targets set by the doctor
- Quit smoking and cut down on alcohol
- Be physically active regularly as advised by the physiotherapist
- Know the warning signs — drooping face, weakness on one side, slurred speech: call 1669 immediately, even if the symptoms have gone (read about TIA)
Regular physical activity is part of preventing another stroke
At KIN • A neurology physician reviews the history, test results and current medicines, together with the original hospital's treatment plan
• Carotid ultrasound at the Kin Charnn Vascular Center, Sukhumvit 107 (call 084-003-6655 or 065-909-2599)
• The rehabilitation team works with the family on exercise, diet and blood pressure monitoring
Consult a Physician | KIN Sukhumvit 107
Book a physician consultation in advance (not for emergencies) · Having stroke symptoms now? Call 1669
Other KIN Rehabilitation locations
Central Hotline: 02-096-4996 | Home physiotherapy 095-767-6307 | Care, nursing and equipment rental 061-881-9399 | Emergency: call 1669
Frequently Asked Questions – Answered by KIN's Medical and Multidisciplinary Team
Can stroke happen again?
Yes. The risk is highest early on and continues for many years, so prevention must be long-term.
I take all my medicines. Why did it happen again?
Even with correct treatment, stroke can recur, because arteries age along with existing conditions, some patients have several causes at once, or risk factors are not yet controlled to target. The right step is to have the doctor review the cause and the control targets. Never stop or change your medicines yourself.
Are antiplatelets different from clot-dissolving medicines?
Yes. What people commonly call "clot-dissolving pills" taken at home, such as warfarin, are medically called anticoagulants, used when the cause is a clot from the heart, whereas antiplatelets, such as aspirin, are used for narrowed arteries. True clot-dissolving drugs (by injection) are used only in the emergency room within the first few hours. Never switch or stop medicines yourself (read more)
Do I need to see a brain doctor if a hospital doctor already looks after me?
Main medicines and follow-up appointments remain with your hospital doctor as before. A neurology physician at the rehabilitation center helps review whether prevention fully matches the cause, and coordinates with the rehabilitation team between appointments.
- Kleindorfer DO, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke. 2021;52(7):e364–e467
- Amarenco P, et al. Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke. N Engl J Med. 2018;378(23):2182–2190
- Underlying Causes of TIA and Minor Ischemic Stroke and Risk of Major Vascular Events. JAMA Neurol. 2023;80(11):1199–1208
- Pendlebury ST, Rothwell PM. Lancet Neurol. 2009;8(11):1006–1018
Written and medically reviewed by Dr. Krichtha Phuengcharoen (License No. 40781), Neurology Physician | Supervised by Dr. Thongchai Chokthanomsap, Chairman of the Executive Board | Last updated: November 2026 | General health information, not individual medical advice. Main medicines and follow-up appointments remain with your own hospital physician.