Bereczki Dániel
Semmelweis Egyetem, Neurológiai Klinika, Budapest.
Neuropsychopharmacol Hung. 2009 Mar;11(1):7-13.
Annually about 50,000 patients are hospitalized for acute stroke in Hungary. Of all stroke cases 85% are ischemic, and 15% are hemorrhagic (intracerebral or subarachnoid). In acute ischemic stroke the only registered causal treatment with proven efficacy is thrombolysis with intravenous administration of recombinant tissue plasminogen activator with a 3-hour time window. The indication areas of intraarterial thrombolysis are currently being established for selected cases in selected centers. Other studies examine the options to extend the time window and to test new thrombolytic agents. Despite the large number of studies none of the neuroprotectant agents have been found beneficial in randomized controlled clinical trials in acute stroke. According to the results of studies to date anticoagulant therapy (heparin) cannot be recommended for the routine treatment of acute stroke. Aspirin may be safely administered within 48 hours of ischemic stroke and results in a 1% decrease of death or disability at 6 months after stroke. There were no large studies on the use of other antiplatelet agents in acute stroke. If thrombolysis is performed, antiplatelet or anticoagulant agents should not be administered in the first 24 hours. Further studies are needed to test the efficacy and safety of anticoagulants in special cases of stroke (e.g. crescendo TIA-s, progressing stroke), and to test combined antiplatelet treatment in the acute phase of stroke. In acute intracerebral hemorrhage the beneficial effect of recombinant coagulation factor VII found in a small study could not be proved in a large phase III trial. Currently there is no evidence based pharmacotherapy for the specific treatment of intracerebral hemorrhage. In subarachnoid hemorrhage nimodipine was found effective in preventing vasospasm and thus secondary ischemic cerebral damage. Although the results of individual trials are conflicting, a systematic review on the effects of statins suggests a similar effect. Due to the limited options of evidence based treatments of acute stroke primary prevention has utmost importance.
在匈牙利，每年约有50000名患者因急性中风住院。在所有中风病例中，85%为缺血性中风，15%为出血性中风（脑内出血或蛛网膜下腔出血）。在急性缺血性中风中，唯一经证实有效的注册因果治疗方法是在3小时时间窗内静脉注射重组组织型纤溶酶原激活剂进行溶栓治疗。目前，选定中心正在为特定病例确定动脉内溶栓的适应症范围。其他研究正在探讨延长时间窗和测试新型溶栓药物的选择。尽管进行了大量研究，但在急性中风的随机对照临床试验中，尚未发现任何神经保护剂有益。根据迄今为止的研究结果，不建议将抗凝治疗（肝素）用于急性中风的常规治疗。阿司匹林可在缺血性中风后48小时内安全使用，可使中风后6个月的死亡或残疾率降低1%。关于其他抗血小板药物在急性中风中的使用，尚无大型研究。如果进行溶栓治疗，在最初24小时内不应使用抗血小板或抗凝药物。需要进一步研究以测试抗凝剂在中风特殊病例（如渐强性短暂性脑缺血发作、进展性中风）中的疗效和安全性，以及测试中风急性期联合抗血小板治疗的效果。在急性脑内出血中，一项小型研究中发现的重组凝血因子VII的有益效果在大型III期试验中未得到证实。目前，尚无基于证据的药物疗法用于脑内出血的特异性治疗。在蛛网膜下腔出血中，尼莫地平被发现可有效预防血管痉挛，从而预防继发性缺血性脑损伤。尽管个别试验结果相互矛盾，但他汀类药物作用的系统评价表明有类似效果。由于急性中风基于证据的治疗选择有限，一级预防至关重要。
