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Der Klinikarzt 2018; 47(03): 96-104
DOI: 10.1055/a-0592-8603
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© Georg Thieme Verlag Stuttgart · New York

Ischämischer und hämorrhagischer Schlaganfall

Was ist bei der Antikoagulation zu beachten?
Henning Schwert
Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart
,
Hansjörg Bäzner
Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart
› Author Affiliations
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Publication History

Publication Date:
29 March 2018 (online)

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Zusammenfassung

Schlaganfälle können entweder durch den Verschluss eines hirnversorgenden Gefäßes (ischämischer Schlaganfall) oder durch eine intrazerebrale Blutung (hämorrhagischer Schlaganfall) hervorgerufen werden. Zur Unterscheidung eines hämorrhagischen Schlaganfalls von einem ischämischen Schlaganfall ist eine Bildgebung mittels Computertomografie (CT) oder Magnetresonanztomografie (MRT) erforderlich. Die strikte Trennung von Ischämie und Hämorrhagierisiko wird der klinischen Problematik häufig nicht gerecht, da das gemeinsame Vorliegen von ischämischen (z. B. im Rahmen massiver mikroangiopathischer Läsionslast) und hämorrhagischen Ereignissen (ICBs, zerebrale Mikroblutungen) häufig ist. Eingriffe in die Blutgerinnung sind zur Therapie und Vorbeugung ischämischer Schlaganfälle sinnvoll und geboten, bei hämorrhagischen Ereignissen aber streng kontraindiziert. Daher ist im Vorfeld eine konsequente Abwägung des potentiellen Nutzens gegenüber möglichen Blutungskomplikationen unabdingbar.

 

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