When are the cardiovascular and stroke risks too high? Pharmacotherapy for stroke prophylaxis.
| Autor: | Gómez-Outes A; a Division of Pharmacology and Clinical Drug Evaluation, Medicines for Human Use , Spanish Agency for Medicines and Medical Devices (AEMPS) , Madrid , Spain., Suárez-Gea ML; a Division of Pharmacology and Clinical Drug Evaluation, Medicines for Human Use , Spanish Agency for Medicines and Medical Devices (AEMPS) , Madrid , Spain., García-Pinilla JM; b UGC de Cardiología y Cirugía Cardiovascular , Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria , Málaga , Spain.; c Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV) , Instituto de Salud Carlos III , Madrid , Spain. |
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| Jazyk: | angličtina |
| Zdroj: | Expert opinion on pharmacotherapy [Expert Opin Pharmacother] 2018 Sep; Vol. 19 (13), pp. 1427-1440. Date of Electronic Publication: 2018 Sep 08. |
| DOI: | 10.1080/14656566.2018.1511703 |
| Abstrakt: | Introduction: Stroke is a significant source of morbidity and mortality in developed countries. Cardioembolic strokes represent approximately 15-30% of all ischemic strokes. They are frequently related to atrial fibrillation (AF) and have a worse prognosis and high recurrence rates when compared to other causes (e.g. atherosclerosis). Areas Covered: This review includes a summary of general and specific scores to assess cardiovascular and stroke risks, with a focus on specific scores available in AF. Recommendations for antithrombotic therapy are also reviewed. Expert Opinion: Several scores are available for the evaluation of stroke risk. They are useful to identify the risk factors that trigger the need for medical interventions. Integrated risk scores with visual interfaces showing the risk of events, with and without the proposed interventions, can aid decision-making. The risk of stroke can definitely be considered too high in those patients with a history of stroke/transient ischemic attack, who need antiplatelet therapy (after a non-cardioembolic stroke) or anticoagulant therapy (after a cardioembolic stroke). For primary prevention of stroke, antiplatelet therapy is not usually recommended, while anticoagulation should be considered if the patient has concomitant AF and at least one additional risk factor unrelated to sex. |
| Databáze: | MEDLINE |
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