Clinical Research in Cardiology

, Volume 95, Supplement 6, pp vi41–vi46 | Cite as

Leitlinien der DSG und der DGN zur Schlaganfalltherapie—neue Therapieaspekte

  • M. Grond
Article

Zusammenfassung

Symptomatische Karotisstenosen sollten operativ nicht später als 14 Tage nach dem initialen Ereignis Schlaganfall behandelt werden; bis zu diesem Zeitpunkt sind Thrombozytenaggregationshemmer zu verabreichen (s. Tab. 1).
Tab. 1

Dosierung von Thrombozytenaggregationshemmern in Abhängigkeit vom Rezidivrisiko

Rezidivrisiko

Applikation von

<4%

≥4%

50–150 mg ASS

2-mal 25 mg ASS+2-mal 200 mg Dipyradimol

Bei intrakraniellen Stenosen wird der Einsatz von Antikoagulanzien wie Warfarin oder Phenprocoumon nicht mehr empfohlen; stattdessen sollten prophylaktisch 100–300 mg ASS gegeben werden. Das Schlaganfallrisiko wird durch die Einnahme von Antihypertensiva signifikant reduziert. Patienten mit fokaler cerebraler Ischämie ist 40 mg Simvastatin zu geben, was zu einer signifikanten Senkung des vaskulären Risikos führt. 100–300 mg ASS erhalten Patienten mit ausschließlich offenem Foramen ovale nach dem ersten cerebralen ischämischen Ereignis. Bei ASS-Rezidiv erfolgt eine orale Antikoagulation mit einer INR von 2,0–3,0 für mindestens zwei Jahre.

Schlüsselwörter

Stenosen Sekundärprävention Thrombozytenaggregationshemmer Antihypertensiva 

Guidelines given by the DSG and DGN concerning stroke therapy—new therapeutic aspects

Summary

Surgeries of symptomatic carotid stenose should not be operated on later than 14 days after stroke; until the operation inhibitors of platelet aggregation have to be administered (Table 1).
Table 1

Dosage of platelet aggregation inhibitors against risk of relapse

Risk of relapse

Application of

<4%

≥4%

50–150 mg aspirin

2×25 mg aspirin+2×200 mg dipyradimol

The application of anticoagulants like warfarin or phenprocoumon in case of intracranial stenoses is no longer recommended. Instead 100–300 mg aspirin should prophylactically be given. The risk of suffering a stroke is significantly reduced by the application of antihypertensives. Patients with focal cerebral ischemia should be given 40 mg of Simvastatin which leads to a significant decrease of vascular risk. After the first cerebral ischemic incidenz patients with open foramen ovale of the heart should be given 100–300 mg aspirin. In case of aspirin relapse an oral anticoagulation has to be carried out with an INR of 2.0 up to 3 for at least one year.

Key words

Stenosis secondary prevention inhibitors of platelet aggregation antihypertensives 

Literatur

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Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • M. Grond
    • 1
  1. 1.Kreisklinikum SiegenSiegenGermany

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