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Erschienen in: Der Internist 12/2012

01.12.2012 | Arzneimitteltherapie

Primär- und Sekundärprävention des Schlaganfalls

verfasst von: PD Dr. F. Masuhr, M.A. Busch

Erschienen in: Die Innere Medizin | Ausgabe 12/2012

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Zusammenfassung

Eine effektive Prävention bleibt trotz beachtlicher Fortschritte in der Akuttherapie die aussichtsreichste Methode zur Senkung der Krankheitslast durch einen Schlaganfall. Ein gesunder Lebensstil und die Behandlung kardiometabolischer Risikofaktoren sind dabei die Eckpfeiler der Primär- und Sekundärprävention. In der Primärprävention sind Thrombozytenfunktionshemmer aufgrund des höheren Blutungsrisikos nicht indiziert. In der Sekundärprävention des ischämischen Schlaganfalls sind sie jedoch wirksam, wobei die konsistentesten Daten für Acetylsalicylsäure und Clopidogrel vorliegen. Neue orale Antikoagulanzien haben gegenüber Vitamin-K-Antagonisten eine geringfügig bessere Wirksamkeit und reduzieren das Risiko intrakranieller Blutungen. Sie bieten die Möglichkeit, Risikopatienten mit Vorhofflimmern, die bislang nicht mit Vitamin-K-Antagonisten behandelt werden konnten, adäquat zu behandeln. Bei symptomfreien Patienten mit Karotisstenose ist der Nutzen einer Operation marginal. Sie sollte vor dem Hintergrund einer optimierten medikamentösen Therapie kritisch betrachtet werden. Für Patienten mit symptomatischen Stenosen ist die Operation der Stentangioplastie aufgrund geringerer periprozeduraler Komplikationen überlegen. Patienten mit symptomatischen intrakraniellen Stenosen oder kryptogenen Schlaganfällen bei persistierendem Foramen ovale sollten medikamentös behandelt werden.
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Metadaten
Titel
Primär- und Sekundärprävention des Schlaganfalls
verfasst von
PD Dr. F. Masuhr
M.A. Busch
Publikationsdatum
01.12.2012
Verlag
Springer-Verlag
Erschienen in
Die Innere Medizin / Ausgabe 12/2012
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-012-3160-0

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