nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2022-3-81-86nnp-1828Research ArticleREVIEWSОБЗОРЫPossibilities of antiplatelet therapy in non-cardioembolic ischemic strokeВозможности антитромбоцитарной терапии при некардиоэмболическом ишемическом инсультеhttps://orcid.org/0000-0002-7682-6672МаксимоваМ. Ю.MaksimovaM. Yu.

125367, Москва, Волоколамское шоссе, 80

80, Volokolamskoye Shosse, Moscow 125367

ncnmaximova@mail.ruhttps://orcid.org/0000-0002-9397-3746АйрапетоваА. С.AirapetovaA. S.

125367, Москва, Волоколамское шоссе, 80

80, Volokolamskoye Shosse, Moscow 125367

ФГБНУ «Научный центр неврологии»РоссияResearch Center of NeurologyRussian Federation2022200620221438186Copyright © Maksimova M.Y., Airapetova A.S., 20222022Максимова М.Ю., Айрапетова А.С.Maksimova M.Y., Airapetova A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/1828

Most patients survive their first non-cardioembolic ischemic stroke (IS), but a significant proportion of them experience a second stroke within the first year. The main directions for the prevention of recurrent IS are antihypertensive and lipid-lowering therapy, control of glucose levels in patients with diabetes mellitus, and smoking cessation. Clinical guidelines recommend the use of antiplatelet therapy in patients with noncardioembolic IS or transient ischemic attack (TIA). The administration of antiplatelet agents to patients who have had a TIA or stroke reduces their risk of recurrent stroke by 23% and the overall risk of vascular events (myocardial infarction, stroke, and death from cardiovascular disease) by 17% (Antithrombotic Trialists' Collaboration, 2009). Acetylsalicylic acid (ASA), the combined use of clopidogrel and ASA, and the combination of ASA with sustained release dipyridamole have been shown to be effective for secondary prevention of non-cardioembolic IS. Intensive antiplatelet therapy reduces the risk of recurrent stroke, but increases the frequency of bleeding.

Большинство пациентов выживают после первого некардиоэмболического ишемического инсульта (ИИ), однако у значительной части из них в течение первого года происходит повторный инсульт. Основными направлениями профилактики повторного ИИ являются проведение гипотензивной и гиполипидемической терапии, контроль уровня глюкозы у больных сахарным диабетом и отказ от курения. В клинических руководствах рекомендуется применение у пациентов с некардиоэмболическим ИИ или транзиторной ишемической атакой (ТИА) антитромбоцитарной терапии. Назначение тромбоцитарных антиагрегантов пациентам, перенесшим ТИА или инсульт, снижает у них риск развития повторного инсульта на 23% и суммарный риск сосудистых событий (инфаркта миокарда, инсульта и смерти от сердечно-сосудистых заболеваний) на 17% (Antithrombotic Trialists’ Collaboration, 2009). Было показано, что для вторичной профилактики некардиоэмболического ИИ эффективны ацетилсалициловая кислота (АСК), комбинированное использование клопидогрела и АСК, сочетание АСК с дипиридамолом замедленного высвобождения. Интенсивная антитромбоцитарная терапия уменьшает риск развития повторного инсульта, однако при этом увеличивается частота кровотечений.

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The authors declare that there are no conflicts of interest present.