Sekundärprävention des Schlaganfalls

Zusammenfassung

Patienten nach einer transitorisch-ischämischen Attacke oder einer zerebralen Ischämie sind von einem hohen Wiederholungsrisiko bedroht. Durch sekundärprophylaktische Maßnahmen sollen erneute zerebrale Ischämien, aber auch andere vaskuläre Erkrankungen (z. B. Myokardinfarkt) nach einem stattgehabten Schlaganfall verhindert werden. Wichtigste Bausteine in der Sekundärprävention der zerebralen Ischämie sind die Behandlung von Risikofaktoren, sowie die Einnahme von Thrombozytenfunktionshemmern bzw. Antikoagulation. An Thrombozytenfunktionshemmern stehen Azetylsalizylsäure (ASS), Clopidogrel und die Kombination aus retardiertem Dipyridamol und ASS zur Verfügung. Ein neues Risikomodell, das einen Anhaltspunkt für eine risikostratifizierte Differenzialtherapie liefern kann, wird vorgestellt.

Summary

Patients suffering a transient ischaemic attack (TIA) or ischaemic stroke (IS) have a high recurrence risk. Secondary prevention aims to prevent not only further strokes but also cardiac events. Important parts of secondary prevention regimens are the modification of vascular risk factors and the inhibition of platelet function or anticoagulation if indicated. The inhibition of platelet function is effective in the reduction of secondary vascular events in patients with TIA or stroke. This is true for acetylsalicylic acid (ASA), clopidogrel, and the combination of ASA plus slow-release dipyridamole. A prediction model which allows to identify patients in whom clopidogrel or dipyridamol plus ASA is superior to ASA for the secondary prevention of stroke is presented.

Schlüsselwörter

Schlaganfall - Sekundärprävention - Thrombozytenfunktionshemmer

Keywords

Stroke - secondary prevention - antiplatelets

• Literatur

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