Di Legge Silvia, Koch Giacomo, Diomedi Marina, Stanzione Paolo, Sallustio Fabrizio
Stroke Unit, Department of Neuroscience, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Stroke Res Treat. 2012;2012:391538. doi: 10.1155/2012/391538. Epub 2012 Nov 4.
Prevention plays a crucial role in counteracting morbidity and mortality related to ischemic stroke. It has been estimated that 50% of stroke are preventable through control of modifiable risk factors and lifestyle changes. Antihypertensive treatment is recommended for both prevention of recurrent stroke and other vascular events. The use of antiplatelets and statins has been shown to reduce the risk of recurrent stroke and other vascular events. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are indicated in stroke prevention because they also promote vascular health. Effective secondary-prevention strategies for selected patients include carotid revascularization for high-grade carotid stenosis and vitamin K antagonist treatment for atrial fibrillation. The results of recent clinical trials investigating new anticoagulants (factor Xa inhibitors and direct thrombin inhibitors) clearly indicate alternative strategies in stroke prevention for patients with atrial fibrillation. This paper describes the current landscape and developments in stroke prevention with special reference to medical treatment in secondary prevention of ischemic stroke.
预防在对抗缺血性中风相关的发病率和死亡率方面起着至关重要的作用。据估计，通过控制可改变的风险因素和改变生活方式，50%的中风是可以预防的。推荐进行抗高血压治疗以预防复发性中风和其他血管事件。使用抗血小板药物和他汀类药物已被证明可降低复发性中风和其他血管事件的风险。血管紧张素转换酶抑制剂（ACEI）和血管紧张素II受体阻滞剂（ARB）可用于中风预防，因为它们也有助于血管健康。针对特定患者的有效二级预防策略包括对重度颈动脉狭窄进行颈动脉血运重建以及对心房颤动进行维生素K拮抗剂治疗。近期研究新型抗凝剂（Xa因子抑制剂和直接凝血酶抑制剂）的临床试验结果明确表明了心房颤动患者中风预防的替代策略。本文描述了中风预防的当前形势和进展，特别提及缺血性中风二级预防中的药物治疗。
