Neues beim Schlaganfall: Prävention

Diese Übersichtsarbeit referiert aktuelle Studien zur Prävention des Schlaganfalls und zur Funktionsverbesserung. Die Autoren haben die wichtigsten Arbeiten aus den 4782 Publikationen im Zeitraum zwischen Herbst 2019 und Oktober 2020 ausgewählt. Neue Studien gibt es zur Behandlung der arteriellen Hypertonie und von Fettstoffwechselstörungen in der Sekundärprävention.

Kernaussagen

• Eine wirksame antihypertensive Therapie reduziert das Risiko erneuter Schlaganfälle bei Patienten mit stattgehabtem Schlaganfall. Die Therapie einer arteriellen Hypertonie reduziert auch das Risiko einer Demenz.

• NOAKs sind bei Patienten mit Vorhofflimmern in der Sekundärprävention wirksamer und sicherer als Vitamin-K-Antagonisten. Besonders hervorzuheben ist die Reduktion intrakranieller Blutungen.

• In 2 großen randomisierten Behandlungsstudien konnte kein Vorteil einer Antikoagulation versus Plättchenhemmung in der sekundären Prävention von Patienten mit ESUS (= embolic Stroke of undetermined Source) gezeigt werden. Die Relevanz des ESUS-Konzeptes ist damit unklar. Die Prophylaxe erfolgt daher mit Acetylsalicylsäure.

• Ein vergrößerter linker Vorhof ist mit einem erhöhten Risiko für Vorhofflimmern assoziiert und könnte ein Hinweis auf eine bessere sekundärprophylaktische Wirkung einer Antikoagulation im Vergleich zu Thrombozytenfunktionshemmern bei ESUS-Patienten sein.

• Die beiden großen ESUS-Studien zeigen keine Übereinstimmung bezüglich der Überlegenheit einer Antikoagulation versus Plättchenhemmung zur Verhinderung schwerer Schlaganfälle.

• Kardiale Biomarker wie das Troponin T korrelieren bei ESUS-Patienten mit dem kardiovaskulären Risiko, eignen sich aber nicht zur Therapiestratifizierung von Antikoagulation versus Plättchenhemmung.

• Selektive Serotonin-Wiederaufnahmehemmer sind in präklinischen Tiermodellen in der Lage die Regeneration nach Schlaganfall zu fördern. Dieser Effekt ließ sich in mehreren randomisierten placebokontrollierten Studien an Schlaganfallpatienten nicht nachweisen.

• S44819 war für die Verbesserung des funktionellen Outcomes nach Schlaganfall in einer Behandlungsphase von 90 Tage nach dem Ereignis einer Therapie mit Placebo nicht überlegen.

Schlüsselwörter

Geriatrie - ischämischer Insult - Sekundärprävention - Apoplex - Thrombembolie - intrazerebrale Blutung - Antikoagulation

Publication History

Article published online:
25 October 2021

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