Secondary prevention of ischemic stroke: from recommendations to real clinical practice
Abstract
Objective: to estimate the quality of basic drug therapy in patients with prior ischemic stroke and to analyze the rate and pattern of cardiovascular events according to the data of a prospective follow-up. Patients and methods. The study included 164 patients with acute ischemic stroke and sinus rhythm. After hospital discharge, the patients were surveyed by telephone survey to assess their compliance and to record cases of cardiovascular events. Results. The duration of the prospective follow-up was 21 (15; 44) months. Thirty-five (21%) patients were found to have cardiovascular events, including fatal ones in 13 (8%) patients. The latter as compared with the others, were older; they were frequently recorded to have recurrent ischemic strokes, stable forms of coronary heart disease (postinfarct cardiosclerosis, angina on exertion), a higher cardiovascular risk by the ESRS scale, they were less frequently treated with antithrombotic agents, indirect anticoagulants in particular (p < 0.05).
References
1. <div><p>Инсульт: диагностика, лечение, профилактика. Под ред. З.А. Суслиной., М.А. Пирадова. М.: МЕДпресс-информ, 2009; 288 с.</p><p>Ворлоу Ч.П., Деннис М.С., ван Гейн Ж. и др. Инсульт. Практическое руководство для ведения больных. Пер. с англ. Под ред. А.А. Скоромца и В.А. Сорокоумова. СПб.: Политехника, 1998; 629 с.</p><p>Dhamoon M.S., Tai W., Boden-Albala B. et al. Risk of myocardial infarction or vascular death after first ischemic stroke. Stroke 2007;38:1752—8.</p><p>Hackman D.G., Spence J.D. Combining multiple approaches for the secondary prevention of vascular events after stroke. A quantitative modeling study. Stroke 2007;38:1881—5.</p><p>Furie K.L., Kasner S.E., Adams R.J. et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:227—76.</p><p>Palnum R.H., Mehnert F., Andersen G. et al. Use of secondary medical prophylaxis and clinical outcome among patients with ischemic stroke. A nationwide follow-up study. Stroke 2012;43:802—7.</p><p>Saposnik G., Goodman S.G., Leiter LA. et al. Applying the evidence: do patients with stroke, coronary artery disease, or both achieve similar treatment goals? Stroke 2009;40:1417—24.</p><p>Carter A.M., Catto A.J., Mansfield M.W. et al. Predictive variables for mortality after acute ischemic stroke. Stroke 2007;38:1873—80.</p><p>Weimar Ch., Benemann J., Michalski D. et al. Prediction of recurrent stroke and vascular death in patients with transient ischemic attack or nondisabling stroke. Stroke 2010;41:487—93.</p><p>Weimar Ch., Diener H-Ch., Alberts M.J. et al. The Essen Stroke Risk Score predicts recurrent cardiovascular events (ESRS). Stroke 2009;40:350—4.</p><p>Рябова В.С. Отдаленные последствия мозгового инсульта (по материалам регистра). Журн невропатол и психиатр 1986;4:532—6.</p><p>Харакоз О.А., Канорский С.Н., Чирва Н.Н. и др. Отдаленная выживаемость больных, перенесших инсульт, и проблема контроля факторов сердечно-сосудистого риска (по данным регистра инсульта в Краснодаре). Журн неврол и психиатр Инсульт 2004;10:66—72.</p><p>Парфенов В.А., Гурак С.В. Повторный ишемический инсульт и его профилактика у больных с артериальной гипертонией. Журн неврол и психиатр. Инсульт 2005;14:3—7.</p><p>Вербицкая С.В., Парфенов В.А. Вторичная профилактика инсульта в амбулаторных условиях. Неврол журн 2011;1:42—6.</p><p>Asberg S., Henriksson K.M., Farahmand B. et al. Ischemic stroke and secondary prevention in clinical practice. Stroke 2010;41:1338—42.</p><p>Wei J.W., Wang Ji-G., Huang Y. et al. Secondary prevention of ischemic stroke in urban China. Stroke 2010;41:967—74.</p><p>Glader E.-L., Sjolander M., Eriksson M. et al. Persistent use of secondary prevention drugs declines rapidly during the first 2 years after stroke. Stroke 2010;41:397—401.</p><p>PATS Collaborating Group. Post-Stroke Antihypertensive Treatment Study: a preliminary result. Chin Med J 1995;108:710—7.</p><p>PROGRESS Collaborative Group. Randomized trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358:1033—41.</p><p>Schrader J.S., Luders S., Kulschewski A. et al. Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention principal results of a prospective randomized controlled study (MOSES). Stroke 2005;36:1218—26.</p><p>Диагностика и лечение фибрилляции предсердий. Рекомендации ВНОК и ВНОА. Рац фармакот в кардиол 2011(Прил.);4:3—80.</p><p>Guyatt G.H., Akl E.A., Crowther M. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl.):7S—47S.</p><p>The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee: Guidelines for management of ischaemic stroke and transient ischaemic attacks 2008. Cerebrovasc Dis 2008;25:457—507.</p><p>Afilalo J., Duque G., Steele R. et al. Statins for secondary prevention in elderly patients: a hierarchical bayesian meta-analysis. J Am Coll Cardiol 2008;51:37—45.</p><p>Amarenko P., Bogouslavsky J., Callahan A. 3rd et al. For the SPARCL investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006;355:549—559.</p><p>Руководство по нарушениям ритма сердца. Под ред. Е.И. Чазова, С.П. Голицына. М.: ГЭОТАР-Медиа, 2008; 416 с.</p><p>Кардиоваскулярная профилактика. Национальные рекомендации. Кардиоваскулярная терапия и профилактика 2011;6 (Прил. 2);3—64.</p></div><br />
Review
For citations:
Shandalin V.A., Fonyakin A.V., Geraskina L.A. Secondary prevention of ischemic stroke: from recommendations to real clinical practice. Neurology, Neuropsychiatry, Psychosomatics. 2012;4(2):35-41. (In Russ.) https://doi.org/10.14412/2074-2711-2012-379
Views: 699
Email this article 