Schlaganfallprävention aus praktisch klinischer Sicht

Zusammenfassung

Der Arzt steht oft vor dem Problem, dass er weiß, was die Leitlinien der DGN zur Sekundärprophylaxe des Schlaganfalles sagen. Nur muss der Arzt einen Patienten, den er z. B. nie in eine Studie hätte aufnehmen können, behandeln. Hierzu bedarf es eines Pragmatismus, der die Kosten für das System, aber vor allem die individuelle Situation des Patienten berücksichtigen muss. Hinzu kommt, dass Studien Fragen offen lassen. Für die Wahl des Aggregationshemmers ist die individuelle Situation des Patienten wichtig. Blutdrucksenkung bei Patienten, die zu wenig Flüssigkeit aufnehmen, muss hinterfragt werden. 24-Stunden- Blutdruckmessungen sollten zur Beurteilungsbasis werden, um nächtliche Blutdruckabfälle nicht zu übersehen. Lipidsenker sind statistisch zwar bei älteren Patienten in der Hirninfarktprophylaxe wirksam, dürften aber kaum die erste und wichtigste Maßnahme darstellen. Wichtig ist bei allen medikamentös möglichen Einzeleffekten die Machbarkeit in der Praxis, z. B. die Gesamtmenge der verordneten Medikamente im Auge zu behalten.

Summary

The physician knows the guidelines from the German Neurology Society (DGN) for the prevention of a second stroke. However, for the treatment of a patient pragmatism is necessary and the costs for the system have to be regarded. Furthermore, clinical studies can leave unanswered questions. For the choice of the aggregation inhibitor the individual situation of the patient should be regarded. Blood pressure has to be observed and regulated. Lipid-lowering agents are effective for elderly patients as prevention, but not as first choice treatment. For every medical treatment, practical and clinical usefulness should be regarded.

Schlüsselwörter

Hirninfarkt Sekundärprävention Aggregationshemmer - Antikoagulation - Kosten

Keywords

Stroke - secondary prevention - aggregation inhibitors - anti-coagulation - costs

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