Stellenwert der Antikoagulation

K. Winbeck; B. Conrad; D. Sander

doi:10.1055/s-0038-1626296

Nervenheilkunde, Table of Contents

Nervenheilkunde 2004; 23(03): 138-142
DOI: 10.1055/s-0038-1626296

Arbeiten zum Schwerpunkt - Theme Articles

Schattauer GmbH

Stellenwert der Antikoagulation

Neues in der SchlaganfallprophylaxeNew aspects of stroke preventionThe role of anticoagulation

K. Winbeck

¹Neurologische Klinik der TU München (Direktor: Prof. Dr. med. Bastian Conrad)

,

B. Conrad

¹Neurologische Klinik der TU München (Direktor: Prof. Dr. med. Bastian Conrad)

,

D. Sander

¹Neurologische Klinik der TU München (Direktor: Prof. Dr. med. Bastian Conrad)

› Author Affiliations

Abstract

Zusammenfassung

Die Bedeutung der Antikoagulation in der Akutphase des ischämischen Schlaganfalls und in der Sekundärprävention hat bereits seit einigen Jahren einen Wandel erfahren. Große Studien konnten keinen positiven Effekt der frühen Antikoagulation nach ischämischem Schlaganfall nachweisen. Bis auf wenige Ausnahmen, wie eindeutige kardiale Emboliequelle, progressive Hirnstammsymptomatik, Sinusvenenthrombosen, Dissektion der hinversorgenden Gefäße und evtl. hochgradige Karotisstenosen vor Operation, hat die Antikoagulation in der Akutphase des ischämischen Schlaganfalls an Bedeutung verloren. In der Sekundärprophylaxe bei kardioembolischen Infarkten stellt sie weiterhin die Therapie der Wahl dar. Darüber hinaus wird die Antikoagulation bei persistierendem Foramen ovale (PFO) und zusätzlichen Vorhofseptumaneurysma diskutiert. Neueste Studien weisen daraufhin, dass die Antikoagulation bei intrakraniellen Stenosen der Thrombozytenaggregationshemmung nicht überlegen ist.

Summary

The role of anticoagulation in acute ischemic stroke and secondary prevention of ischemic stroke has been changed in the last years. Several large studies could not demonstrate a significant benefit of early anticoagulation in patients with acute stroke. Possible remaining indications for acute anticoagulation were an undoubtful cardioembolic cause of the stroke, progressive stroke, intracranial sinus venous thrombosis, dissections of cerebral arteries and high grade carotid stenosis before CEA. For secondary prevention of cardioembolic stroke anticoagulation is the first line treatment. Recently anticoagulation is discussed in patients with persistent foramen ovale and atrial septum aneurysm (ASA). For the treatment of intracranial stenosis oral anticoagulation might be better than aspirin.

Schlüsselwörter

Schlaganfall - Antikoagulation - Vorhofflimmern - persistierendes Foramen ovale - intrakranielle Stenosen

Keywords

Stroke - anticoagulation - atrial fibrillation - persistent foramen ovale - intracranial stenosis

Full Text

References

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