Treatment and secondary prevention of stroke: evidence, costs, and effects on individuals and populations
Treatment and secondary prevention of stroke: evidence, costs, and effects on individuals and populations
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DOI：
10.1016/s0140-6736(99)04407-4
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发表时间：
1999-10-23
期刊：
影响因子：
168.9
通讯作者：
Warlow, CI
中科院分区：
文献类型：
--
作者：
Hankey, GJ;Warlow, CI
对急性卒中治疗有效性和二级预防方法的回顾表明，卒中服务提供者的最高优先级必须是建立卒中单元和多学科团队，提供有组织的卒中护理。急性缺血性卒中患者应立即开始服用阿司匹林，每日300 mg，如果可能的话，其中许多患者应进入进一步的溶栓试验和其他有希望的治疗。急性期后，应继续使用较低剂量的阿司匹林，每日75 mg;不鼓励吸烟;高血压最初使用利尿剂治疗;缺血性卒中/短暂性脑缺血发作幸存者长期使用华法林抗凝，如果抗凝不敏感，则给予阿司匹林。他汀类药物可能适用于已经有症状的冠心病患者。在阿司匹林中加入双嘧达莫，用氯吡格雷代替阿司匹林，以及颈动脉内膜切除术都是预防中风的昂贵干预措施，但如果能找到方法将其集中在特别高风险的患者身上，它们将变得更便宜。
This review of the effectiveness of treatment for acute stroke and methods of secondary prevention shows that the highest priority for providers of a stroke service must be to establish a stroke unit and multidisciplinary team that delivers organised stroke care. Acute ischaemic stroke patients should be immediately started on aspirin 300 mg daily, and, if possible, many of them should be entered into further trials of thrombolysis and other promising treatments. After the acute phase, aspirin should be continued in a lower dose, 75 mg daily; smoking should be discouraged; high blood pressure treated initially with a diuretic; and fibrillating ischaemic stroke/transient ischaemic attack survivors anticoagulated long-term with warfarin or given aspirin if anticoagulation is not sensible. Statins are probably indicated in patients who already have symptomatic coronary heart disease. Adding dipyridamole to aspirin, substituting clopidogrel for aspirin, and carotid endarterectomy are all expensive interventions to prevent stroke, but if ways could be found to focus them on those patients at especially high risk, they would become more affordable.