Primär- und Sekundärprävention des Schlaganfalls

Peter Trenkwalder; Andreas Rüchardt

doi:10.1055/s-0041-103118

DMW - Deutsche Medizinische Wochenschrift, Table of Contents

Dtsch Med Wochenschr 2015; 140(21): 1593-1598
DOI: 10.1055/s-0041-103118

Dossier

Schlaganfall / vaskuläre Demenz

Primär- und Sekundärprävention des Schlaganfalls

Primary and secondary prevention of stroke

Authors

Peter Trenkwalder

¹Medizinische Klinik, Klinikum Starnberg, Starnberg
Andreas Rüchardt

¹Medizinische Klinik, Klinikum Starnberg, Starnberg

Abstract

Zusammenfassung

Die Grundlage der Primär- und Sekundärprävention des Schlaganfalles (gilt analog auch für die transiente ischämische Attacke [TIA]) ist eine gesunde Lebensführung mit gesunder Ernährung, Nichtrauchen, Gewichtsreduktion und regelmäßiger Bewegung sowie die konsequente Behandlung der arteriellen Hypertonie mit Zielwerten < 140 /90 mmHg. Die Auswahl der Antihypertensiva richtet sich nach den Begleiterkrankungen, wichtiger als die Substanzklasse ist das Erreichen der Zielwerte. Während die Cholesterinsenkung mit Statinen in der Primärprävention vom kardiovaskulären Gesamtrisiko abhängt, ist sie heute fester Teil der Sekundärprävention des nicht-kardioembolischen Schlaganfalles. Vorhofflimmern ist eine der häufigsten Schlaganfallursachen und sollte abhängig vom CHA₂DS₂-VASc-Score antikoaguliert werden. Die Thrombozytenaggregationshemmung ist nach allen nicht-kardioembolischen Schlaganfällen lebenslang indiziert, in der Primärprävention nur bei hohem kardiovaskulärem Gesamtrisiko. Findet sich eine asymptomatische Karotisstenose, ist das weitere therapeutische Vorgehen individuell festzulegen, die symptomatische Karotisstenose sollte rasch nach dem Ereignis interventionell angegangen werden.

Abstract

The basis for primary and secondary prevention of stroke (and also TIA) are both a healthy lifestyle with a healthy diet, non smoking, weight reduction and regular exercise, and consistent treatment of arterial hypertension with a target of < 140 /90 mmHg. The choice of the antihypertensive is depending on concomitant diseases, more important than the class of antihypertensive is treatment to target. Reduction of cholesterol with statins in primary prevention is dependant on total cardiovascular risk, in secondary prevention statins are integral part of modern treatment in non cardioembolic stroke. Atrial fibrillation is one of the major causes of stroke and should be treated with anticoagulation depending on the CHA₂DS₂-VASc score. Platelet inhibition is mandatory lifelong in all non cardioembolic strokes, in primary prevention only for patients with high total cardiovascular risk. Treatment of asymptomatic carotid artery stenosis should be determined on an individual basis. Symptomatic carotid artery stenosis should be treated immediately after the index stroke.

Schlüsselwörter

Schlaganfall - transiente ischämische Attacke - Primärprävention - Sekundärprävention - Lebensstiländerungen - Vorhofflimmern - Antikoagulation - Thrombozytenaggregationshemmung

Keywords

Stroke - transient ischemic attack - primary prevention - secondary prevention - lifestyle changes - atrial fibrillation - anticoagulation - platelet inhibition

Full Text

References

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