Medikamentöse Massnahmen bei der Betreuung Zerebrovaskulärer Patienten

Drugs to prevent ischaemic stroke. Stroke is the third leading cause of death, the second most common cause of dementia and the leading reason for long-term disability in most industrialised populations. A healthy lifestyle (no smoking, regular physical activity, diet for normal body weight) and treatment of vascular risk factors can prevent a substantial number of strokes. Some groups of the population are at especially high risk to suffer a first or recurrent stroke. Stroke victims or persons after a TIA represent such a high risk population (20 to 40% recurrent stroke risk during the first 5 years) and need special attention: in patients with noncardioembolic stroke antiplatelet agents such as aspirin, aspirin plus dipyridamole or clopidogrel are recommended. In case of recurrent stroke, aspirin intolerance or multiple vascular risk factors we prefer clopidogrel. In patients with cardioembolic stroke (e.g. atrial fibrillation, cardiac clot formation), extracranial carotid or vertebral artery dissection, cerebral sinus venous thrombosis or hypercoagulability, anticoagulation is indicated. Treatment of arterial hypertension significantly reduces the risk of both first and recurrent cerebrovascular events. Antihypertensive agents are of paramount importance in both primary and secondary stroke prevention. The role of statins is also fairly well established after stroke. They reduce recurrent stroke and other types of vascular events overall. In diabetic patients strict treatment of elevated blood pressure (>130/80 mm Hg) and dyslipidaemia should be attempted in order to minimise stroke risk. Control of hyperglycaemia is important to avoid microangiopathy.