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DOI: 10.1055/a-1719-9328
Neues in der Prävention des Schlaganfalls
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Diese Übersichtsarbeit referiert aktuelle Studien zur Prävention des Schlaganfalls und zur Funktionsverbesserung nach Schlaganfall. Die Autoren haben die wichtigsten Publikationen aus den Jahren 2020 und 2021 zusammengestellt.
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Eine wirksame antihypertensive Therapie reduziert das Risiko erneuter Schlaganfälle bei Patienten nach Schlaganfall.
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Die Therapie einer arteriellen Hypertonie reduziert auch das Risiko einer Demenz.
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NOAKs sind bei Patienten mit Vorhofflimmern in der Sekundärprävention wirksamer und sicherer als Vitamin-K-Antagonisten. Besonders hervorzuheben ist die Reduktion intrakranieller Blutungen.
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Eine orale Antikoagulation reduziert bei Patienten mit Vorhofflimmern das Risiko einer Demenz.
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Die frühe Sekundärprävention nach Hochrisiko-TIA oder leichtem ischämischem Insult sollte mit einer Kombination von Aspirin und Clopidogrel oder Aspirin und Ticagrelor für 21 Tage erfolgen.
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In zwei großen randomisierten Behandlungsstudien konnte kein Vorteil einer Antikoagulation versus Plättchenhemmung in der sekundären Prävention von Patienten mit ESUS gezeigt werden. Die Relevanz des derzeitigen ESUS-Konzeptes ist damit unklar.
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Ein vergrößerter linker Vorhof ist mit einem erhöhten Risiko für Vorhofflimmern assoziiert und könnte ein Hinweis für eine bessere sekundärprophylaktische Wirkung einer Antikoagulation im Vergleich zu Thrombozytenfunktionshemmern bei ESUS-Patienten sein.
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Die beiden großen ESUS-Studien zeigen keine Übereinstimmung bezüglich der Überlegenheit einer Antikoagulation versus Plättchenhemmung zur Verhinderung schwerer Schlaganfälle.
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Kardiale Biomarker wie das Troponin T korrelieren bei ESUS-Patienten mit dem kardiovaskulären Risiko, eignen sich aber nicht zur Therapiestratifizierung von Antikoagulation versus Plättchenhemmung.
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Bei Patienten mit hochgradigen symptomatischen Stenosen der A. carotis interna wird eine Endarteriektomie empfohlen.
Schlüsselwörter
Hirninfarkt - Gehirnblutung - transitorische ischämische Attacke - TIA - Geriatrie - ischämischer Insult - Sekundärprävention - intrazerebrale Blutung - Thrombozytenfunktionshemmer - AntikoagulationPublication History
Article published online:
07 June 2022
© 2022. Thieme. All rights reserved.
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