特集 トータルケアの視点に立った脳卒中医療・アップデート
脳卒中慢性期再発予防療法（二次予防）
2019 年 36 巻 2 号 p. 85-90
詳細
2019 年 36 巻 2 号 p. 85-90
For the secondary prevention of stroke, the strict control of risk factors and the appropriate prescription of antithrombotic agents are necessary. The blood pressure level target for secondary stroke prevention is <140/90mmHg, but more strict control, i.e., <130/80mmHg as the target, is recommended for hemorrhagic stroke patients and for ischemic stroke patients with antithrombotic agents. In the control of dyslipidemia, PCSK9 inhibitors are expected to prevent the recurrence of stroke in ischemic stroke patients. Probucol has a strong anti–oxidative effect for LDL cholesterol. The recent PICASSO trial revealed significant efficacy of probucol in ischemic stroke patients who are at high risk of hemorrhage. The combination of antiplatelet therapy with cilostazol (CSPS.com) is effective in the secondary prevention of stroke among noncardiogenic ischemic stroke patients. Clinical trials have shown that in patients with atrial fibrillation, the Watchman left atrial appendage closure device is more effective than medical treatment using warfarin. A patent foramen ovale (PFO) closure device showed efficiency in cryptogenic ischemic stroke patients with a PFO.
