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Acetylsalicylsäure in der Prävention zerebrovaskulärer Erkrankungen

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Acetylsalicylsäure im Kardiovaskulären System

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Zusammenfassung

Im Bereich der Prävention zerebrovaskulärer Erkrankungen ist Acetylsalicylsäure die am häufigsten eingesetzte und klinisch am besten untersuchte Substanz. Während Primärpräventionsstudien keinen prophylaktischen Effekt einer Behandlung mit Acetylsalicylsäure bezüglich des Auftretens von Schlaganfällen zeigen konnten, ist die protektive Wirkung in der Sekundärprophylaxe nach TIA oder inkomplettem Schlaganfall bei Frauen und Männern gesichert. Umstritten ist jedoch die optimale Dosis, die einen ausreichenden Schutz bei möglichst niedriger Nebenwirkungsrate bietet. Da ausreichend große kontrollierte klinische Studien, die einen direkten Dosisvergleich durchrühren, derzeit fehlen, empfehlen wir, 300 mg pro Tag in der Sekundärprävention nach TIA oder inkomplettem Schlaganfall einzusetzen. Kommt es zu Unverträglichkeiten, kann alternativ der Thrombozyterminktionshemmer Ticlopidin in einer Dosis von 2 × 250 mg pro Tag eingesetzt werden. Bei Patienten mit nicht-rheumatischem Vorhofflimmern ist Acetylsalicylsäure einer Therapie mit Antikoagulantien deutlich unterlegen und kommt nur in Betracht, wenn Kontraindikationen gegen eine Antikoagulation vorliegen. Patienten mit einer asymptomatischen Karotisstenose profitieren von einer Behandlung mit Acetylsalicylsäure durch die Reduktion der hohen Rate an Myokardinfarkten, eine Senkung des Schlaganfallrisikos durch Acetylsalicylsäure ist in dieser Patientengruppe jedoch nicht gesichert.

Summary

Acetylsalicylic acid ist the most widely used and clinically tested substance in the prevention of stroke. Although acetylsalicylic acid showed no significant risk reduction of stroke in „primary prevention trials“, there is a clear evidence of its protective effect in patients with a prior history of minor stroke or transient ischemic attacks. However, the optimal dose of acetylsalicylic acid for stroke prevention, carrying the lowest rate of side effects, is still not known. Since controlled clinical trials, which show a substantial advantage of either high or low doses of acetylsalicylic acid, are still lacking, we propose a dose of 300 mg daily for stroke-prone patients. If side effects occur during treatment with acetylsalicylic acid, the use of ticlopidine (2 × 250 mg daily) may serve as an alternative antiplatelet therapy. The efficacy of acetylsalicylic acid to prevent stroke in patients with atrial fibrillation was substantially smaller compared to warfarin and only patients with contraindications to oral anticoagulation should be considered for acetylsalicylic acid treatment. Patients with asymptomatic carotid artery disease should receive acetylsalicylic acid because it reduces the high rate of myocardial infarction seen in these patients. However, its beneficial effect to prevent stroke in patients with asymptomatic carotid artery disease remains unclear.

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Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Neurologie, Medizinische Fakultät der Humboldt-Universität Berlin - Charité, Schumannstr. 20-21/S NP, D-10117, Berlin, Germany

    K. M. Einhäupl & F. Masuhr

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  1. K. M. Einhäupl
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  2. F. Masuhr
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Editors and Affiliations

  1. Institutes für Pharmakologie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, D-40225, Düsseldorf, Deutschland

    K. Schrör (Direktor) (Direktor)

  2. International Institute of Thrombosis and Vascular Diseases, Ferdinand-Schrey-Weg 6, D-60598, Frankfurt am Main, Deutschland

    H. K. Breddin

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© 1996 Birkhäuser Verlag Basel/Switzerland

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Einhäupl, K.M., Masuhr, F. (1996). Acetylsalicylsäure in der Prävention zerebrovaskulärer Erkrankungen. In: Schrör, K., Breddin, H.K. (eds) Acetylsalicylsäure im Kardiovaskulären System. Birkhäuser Basel. https://doi.org/10.1007/978-3-0348-7574-5_8

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  • DOI: https://doi.org/10.1007/978-3-0348-7574-5_8

  • Publisher Name: Birkhäuser Basel

  • Print ISBN: 978-3-0348-7575-2

  • Online ISBN: 978-3-0348-7574-5

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