Neues in der Primär- und Sekundärprävention des Schlaganfalls

Zusammenfassung

Anhand von selektierten Publikationen aus dem Jahr 2012 werden aktuelle Entwicklungen und Neuheiten in der Primär- und Sekundärprävention des Schlaganfalls dargestellt, die im folgenden stichwortartig zusammengefasst werden: Nierenerkrankungen sind ein unabhängiger Risikofaktor für Schlaganfall bei Patienten mit Vorhofflimmern. Auch kürzere körperliche Aktivität von 90 min pro Woche senkt das Schlaganfallrisiko. Azetylsalizylsäure (ASS) ist zur Primärprophylaxe von Schlaganfällen aufgrund der erhöhten Blutungsgefahr nicht zu empfehlen. Statine erhöhen nicht das Risiko von Hirnblutungen. Nimodipin bleibt die einzige effektive medikamentöse Behandlungsoption von Vasospasmen nach Subarachnoidalblutungen. Die Kombination von ASS und Clopidogrel führt auch bei Patienten mit kleinen subkortikalen Infarkten zu einer Erhöhung des Blutungsrisikos. Vorapaxar ist aufgrund des erhöhten intrakraniellen Blutungsrisikos nicht zur Sekundärprophylaxe nach Schlaganfall geeignet. Der transfemorale Schirmchenverschluss bei Patienten mit kryptogenem Schlaganfall und offenem Foramen ovale verhindert in einer ersten randomisierten Studie keine Schlaganfälle über einen Nachbeobachtungszeitraum von 2 Jahren. Ein extra-/intrakranieller Bypass ist sekundärprophylaktisch nicht wirksam bei Patienten mit einem symptomatischen Karotisverschluss und einem dadurch bedingten hämodynamischen Defizit. Die neuen oralen Antikoagulanzien sind auch effektiv bei Vorhofflimmerpatienten mit früherem Schlaganfall.

Abstract

Based on selected publications from 2012, current developments and innovations in primary and secondary prevention of stroke are reviewed. In patients with atrial fibrillation, renal disease is an independent risk factor for stroke. Physical activity for 90 minutes per week reduces the risk of stroke. Aspirin (acetylsalicylic acid) is not recommended for primary prevention of stroke because it increases the risk of bleeding complications. Statin therapy does not increase the risk of intracranial haemorrhage. Nimodipine remains the only effective non-invasive medical option for vasospasm in subarachnoid haemorrhage. The combination of aspirin and clopidogrel increases the risk of bleeding complications in patients with minor lacunar stroke. Vorapaxar increases the risk of intracranial bleeding and is not recommended for stroke prevention. Data from the first randomised trial indicate that endovascular closure of a patent foramen ovale (PFO) in patients with cryptogenic stroke does not prevent recurrent stroke over a follow-up of 2 years. Extra-/intracranial cerebral artery bypass operation is not effective for secondary stroke prevention in patients with haemodynamically relevant carotid artery occlusion. The novel oral anticoagulant drugs are also effective in patients with atrial fibrillation and prior stroke.

Schlüsselwörter

Schlaganfall - Hirninfarkt - TIA - Prävention

Keywords

stroke - cerebral ischemia - TIA - prevention

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