Medikamentöse Sekundärprävention des ischämischen Schlaganfalls – Empfehlungen für den klinischen Alltag

Der Schlaganfall ist die dritthäufigste Todesursache und die führende Ursache für erworbene Behinderungen in Deutschland, wo jährlich über 260 000 Schlaganfälle auftreten. Etwa ein Viertel dieser Patienten werden dabei aufgrund eines Schlaganfallrezidivs behandelt, was die Bedeutung der (medikamentösen) Sekundärprävention unterstreicht. Diesbezüglich evidenzbasiert sind – bei gegebener Indikation – der Einsatz von oralen Antikoagulanzien, Thrombozytenaggregationshemmern, Antihypertensiva bzw. Statinen. Eine optimierte medikamentöse Sekundärprävention kann zudem effektiv andere vaskuläre Ereignisse bei Schlaganfallpatienten verhindern, wie Herzinfarkte oder vaskuläre Todesfälle. Eine für den klinischen Alltag sehr hilfreiche Zusammenfassung der diesbezüglichen Datenlage stellt die unlängst publizierte S3-Leitlinie zur „Sekundärprophylaxe des ischämischen Insultes“ dar. In diesem Artikel sollen deren wesentliche Inhalte dargelegt und Empfehlungen für die Praxis gegeben werden. Zudem wurden aktuelle Publikationen zur medikamentösen Sekundärprävention berücksichtigt.

Stroke is the third leading cause of death and the leading cause of acquired disability in adulthood in Germany where more than 260,000 strokes occur per year. Approximately 25 % of these strokes are recurrent strokes – underlining the importance of (medical) secondary stroke prevention. Evidence based therapeutic approaches are - at given indication - the use of oral anticoagulants, antiplatelets, antihypertensive drugs or statins. Moreover, optimized medical stroke prevention can reduce other vascular events like myocardial infarction or vascular death. A very helpful guideline for daily clinical practice is the German S3-guideline on secondary stroke prevention which was been published recently. This review outlines the main conclusions of this S3-guideline and incorporates more recent publications on medical secondary stroke prevention providing recommendations for daily clinical practice.

Key words

Antihypertensive drugs - anticoagulation - antiplatelets - atrial fibrillation - ischemic stroke –secondary prevention - statins

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