[Drug therapy after stroke should be evidence-based. Organizational, economic and ethical decisions direct the choice of treatment].
Five types of drug therapy can be considered after stroke: antiplatelet therapy, anticoagulation with heparin or warfarin, blood-pressure-lowering therapy with ACE-inhibitors and diuretics, and finally cholesterol-lowering with statins. Aspirin therapy is the best-documented treatment to avoid another stroke, both in the acute and the long-term perspective. Warfarin treatment is fairly well documented for stroke patients with atrial fibrillation. Heparin therapy increases the risk for serious haemorrhage. Blood-pressure-lowering with a combined ACE-inhibitor and diuretic regimen has been shown to reduce the recurrence rate in younger patients with hemorrhagic as well as ischemic stroke. Statin therapy could be offered to younger stroke patients with a history of coronary heart disease. The increased occurrence of malignant diseases during statin therapy in elderly patients in one study deserves further investigations.
Terént
Andreas
A
Strokesektionen, Medicincentrum, Akademiska sjukhuset, Uppsala. andreas.terent@akademiska.se
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D000959:Antihypertensive Agents; D004232:Diuretics; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D006493:Heparin