Consilium MedicumConsilium MedicumConsilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum9517910.26442/20751753.2019.9.190571ArticlesСтатьиReview ArticleRECURRENT ISCHEMIC STROKE PREVENTIONПРОФИЛАКТИКА ПОВТОРНОГО ИШЕМИЧЕСКОГО ИНСУЛЬТАPILIPOVICHANNA A.ПИЛИПОВИЧАННА АЛЕКСАНДРОВНА

Cand. Sci. (Med.), Sechenov First Moscow State Medical University (Sechenov University)

канд. мед. наук, доц. каф. нервных болезней Института профессионального образования ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)

aapilipovich@mail.ruSechenov First Moscow State Medical University (Sechenov University)ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)15092019219VOL 21, NO9 (2019)ТОМ 21, №9 (2019)333828122021Copyright ©; 2019, Consilium MedicumCopyright ©; 2019, ООО "Консилиум Медикум"2019Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://consilium.orscience.ru/2075-1753/article/view/95179

Cardiovascular disorders are one of the primary mortality causes in Russia. Among them stroke has the second place after acute myocardial infarction. Only 16-13% of patients make a full recovery after ischemic stroke (IS) and return to their former way of life. In most of the patients disease results in disability or death. About 1/2 of IS of transient ischemic attack (TIA) survivors have a recurrent stroke in several days of weeks. A considerable number of recurrent strokes can be prevented with modern methods of secondary prevention. The article discusses tactics of risk factors control and antiplatelet therapy use in prevention of recurrent IS (RIS) based on American Heart Association (AHA) and American Stroke Association (ASA) guidelines with the focus on noncardioembolic stroke treatment. TIA and IS prevention is equally important and modern AHA/ASA guidelines are used in both. Alternatives of RIS prevention with the use of antiplatelet therapy (medications acetylsalicylic acid, clopidogrel, dipiridamol and their combinations); indications, adverse effects, effectiveness and safety, therapeutic dosages are described according to evidence based medicine data.

В России болезни системы кровообращения лидируют в структуре смертности, инсульт стоит на 2-м месте после инфаркта миокарда. Только 16-13% пациентов полностью выздоравливают после ишемического инсульта (ИИ) и возвращаются к прежнему образу жизни, большинство приобретают стойкую инвалидизацию или умирают. Примерно у 1/2 пациентов, переживших ИИ или транзиторную ишемическую атаку (ТИА), в течение нескольких дней или недель случается повторный инсульт. Значительное число рецидивов инсульта может быть предотвращено современными методами вторичной профилактики. В статье обсуждается тактика управления факторами риска и антитромботической терапии с целью профилактики рецидивирующего ИИ (РИИ), основанная на рекомендациях Американской кардиологической ассоциации (AHA) и Американской ассоциации инсульта (ASA), с акцентом на лечение некардиоэмболического инсульта. Предотвращение ТИА и ИИ одинаково важно, и текущие рекомендации AHA/ASA применяются к обоим. Рассмотрены варианты профилактики РИИ с помощью антитромботической терапии (препаратами ацетилсалициловая кислота, клопидогрел, дипиридамол и их сочетаниями), описаны показания, побочные эффекты, эффективность и переносимость, терапевтические дозировки препаратов, согласно данным доказательной медицины.

ischemic strokerecurrent strokerecurrent stroke preventionantiplatelet therapyacetylsalicylic acidишемический инсультрецидивирующий инсультпрофилактика повторного инсультаантиагрегантыацетилсалициловая кислотаСуслина З.А., Варакин Ю.Я. Клиническое руководство по ранней диагностике, лечению и профилактике сосудистых заболеваний головного мозга. М.: МЕДпресс-информ, 2015. ВЫБОР СПЕЦИАЛИСТОВ1 для первичной и вторичной профилактики2 • инфаркта миокарда • ишемического инсульта • стабильной и нестабильной стенокардии • тромбозов глубоких вен • тромбоэмболии после операций ПОБЕДИТЕЛЬ ПРЕМИИ «ЗЕЛЕНЫЙ КРЕСТ 2018» В НОМИНАЦИИ «ПРЕПАРАТ ВЫБОРА ДЛЯ ПРОФИЛАКТИКИ ИНСУЛЬТА И ИНФАРКТА» Per, уд. 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