Rational Pharmacotherapy in Cardiology

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Stroke secondary prevention in internist practice is discussed in accordance with up to date guidelines. Modern pharmacotherapy includes antiaggregants or anticoagulants, statins, and antihypertensive drugs. The choice of drugs is mostly founded on the rules of evidence based medicine, which allow adjusting individual treatment depending on clinical conditions. The composition of perindopril and indapamide is a preferred nowadays combination of antihypertensive drugs.

About the Authors

D. A. Napalkov
I.M. Setchenov First Moscow State Medical University
Russian Federation

A. V. Zhilenko
I.M. Setchenov First Moscow State Medical University
Russian Federation


1. WHO atlas of heart disease and stroke. Available on: Accessed July 8, 2009.

2. Truelsen T., Piechowski-Jу wiak B., Bonita R., Mathers C., Bogousslavsky J., Boysen G. Stroke incidence and prevalence in Europe: a review of available data. Eur J Neurol 2006; 13(6): 581–598.

3. Paul S.L., Srikanth V.K., Thrift A.G. The large and growing burden of stroke. Curr Drug Targets 2007; 8(7): 786–793.

4. Coull A.J., Lovett J.K., Rothwell P.M. Oxford Vascular Study. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ 2004; 328(7435): 326.

5. Weisman S.M. and Graham D.Y. Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events. Archives of Internal Medicine 2002; 162 (19): 2197–2202.

6. Chen Z.M. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet 1997; 349 (9066): 1641–1649.

7. Chen Z., Sandercock P., Pan H. et al. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40 000 randomized patients from the Chinese Acute Stroke Trial and the International Stroke Trial. Stroke 2000; 31 (6): 1240–1249.

8. International Stroke Trial collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke. Lancet 1997; 349 (9065): 1569–1581.

9. Patrono C. and Rocca B. Aspirin: promise and resistance in the new millennium. Arteriosclerosis, Thrombosis, and Vascular Biology 2008; 28 (3): s25–s32.

10. Diener H.C., Cunha L., Forbes C., Sivenius J., Smets P. and Lowenthal A. European stroke prevention study 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neur Sci 1996; 143 (1-2): 1–13.

11. Halkes P.H., van Gijn J., Kappelle L.J., Koudstaal P.J and Algra A. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomized controlled trial. Lancet, 2006; 367: 1665–1673.

12. Sacco R.L., Diener H.-C., Yusuf S. et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. New Engl J Med 2008; 359 (12): 1238–1251.

13. Gent M. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348 (9038): 1329–1339.

14. Diener H.C., Bogousslavsky J., Brass L.M. et al. MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomized, doubleblind, placebo-controlled trial. Lancet, 2004; 364 (9431): 331–337.

15. Bhatt B.L. and Topol E.J. Clopidogrel added to aspirin versus aspirin alone in secondary prevention and high-risk primary prevention: rationale and design of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial. Am Heart J 2004; 148 (2): 263–268.

16. Connolly S.J., Pogue J., Hart R.G. et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. New Engl J Med 2009; 360 (20): 2066–2078.

17. Fuster V., Rydén L.E., Cannom D.S. et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2007; 116 (6): e138.

18. Samsa G.P., Matchar D.B., Goldstein L.B. et al. Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities. Arch Intern Med 2000; 160: 967-73.

19. Amarenco P., Lavallëe P.C., Mazighi M., Labreuche J. Statins in stroke prevention. Future Lipidology 2008; 3(3): 319-325.

20. Amarenco P., Bogousslavsky J., Callahan A. 3rd et al. for the SPARCL Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355 (6): 549-555.

21. Furie K.L., Kasner S.E., Adams R.J. et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011; 42:00-00.

22. PROGRESS Management Committee. Blood pressure lowering for the secondary prevention of stroke: rationale and design for PROGRESS (Perindopril Protection Against Recurrent Stroke Study). J Hypertens Suppl 1996; 14 (2): 41-45.

For citation:

Napalkov D.A., Zhilenko A.V. STROKE PREVENTION IN INTERNIST PRACTICE. Rational Pharmacotherapy in Cardiology. 2011;7(3):342-346. (In Russ.)

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