Neues in der Prävention des Schlaganfalls

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.

Kernaussagen

• Eine wirksame antihypertensive Therapie reduziert das Risiko erneuter Schlaganfälle bei Patienten nach 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.

• Eine orale Antikoagulation reduziert bei Patienten mit Vorhofflimmern das Risiko einer Demenz.

• 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.

• 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.

• 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.

• 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.

• 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 - Antikoagulation

Publication History

Article published online:
07 June 2022

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