Pharmacological Secondary Prevention of Noncardioembolic Cerebral Infarction/Transitory Ischemic Attack – Presence and Future

Authors: doc. MUDr. Zbyněk Kalita, CSc.
Published in: Cesk Slov Neurol N 2011; 74/107(3): 261-272
Category: Review Article


There is a high risk of ischemic stroke (CVE) recurrence and thus its prevention is important. Prevention is based on a systematic monitoring of primary risk factors and pharmacological prevention with antiplatelet drugs. The single most important risk factor is hypertension; an effective treatment of hypertension significantly reduces the risk of CVE recurrence. The recommended target blood pressure is 130–140/80–85 mmHg. Dyslipidemia and its treatment are also considered as a key measure to reduce the risk of recurrence of ischemic CVE. Diabetes mellitus compensation is an important factor in reducing microvascular and macrovascular complications. Less intensive treatment regimens are being recommended to achieve glycated hemoglobin values between 5.3–6.2%. The antiplatelet agent clopidogrel or a combination of acetylsalicylic acid (ASA) with slow-release dipyridamole are recommended, ASA is an alternative. An intensive development of new molecules, P2Y12 receptor antagonists, continues. These are currently tested in cardiology indications. Recent studies, investigating the effectiveness of new antiplatelet drugs (terutroban, a thrombin receptor antagonist). did not prove higher effectiveness in the secondary prevention of ischemic stroke than ASA.

Key words:
secondary prevention of ischemic stroke – arterial hypertension – hyperlipidemia – hyperglycaemia – antiplatelet drugs – aspirin – dipyridamole – clopidogrel – thrombin receptor antagonist


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