[Large trials in the secondary prevention of stroke].
To date, no drug has been demonstrated as efficacious in the treatment of acute ischemic stroke. Therefore, primary and secondary prevention play a fundamental role. Besides adequate control of risk factors, trials and meta-analyses have demonstrated that both medical and surgical therapy are effective in secondary prevention of stroke. In patients with atherothrombotic transient ischemic attack (TIA) or minor stroke and carotid stenosis > 70%, surgical therapy (endarterectomy) is the treatment of choice, while antiplatelet drugs are the elective treatment in the case of stenosis < 70%. Acetylsalicylic acid is the first choice medical treatment, but the optimal dosage is still a matter of debate. Ticlopidine has an efficacy similar to that of aspirin, but shows a certain number of side effects; recently a European study has shown the efficacy of dipyridamole, and the superiority of the combination dipyridamole-aspirin vs low-dose aspirin. In the secondary prevention of cardioembolic stroke, oral anticoagulants have higher efficacy than antiplatelet drugs, at least in selected groups of patients.
Gensini
G F
GF
Istituto di Clinica Medica Generale e Cardiologia, Università degli Studi di Firenze.
Simone
I
I
Pantoni
L
L
Inzitari
D
D
D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D004176:Dipyridamole / Q000627:therapeutic use; D004691:Endarterectomy; D006801:Humans; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D001241:Aspirin