phenprocoumon and Hypertension

In numerous situations stroke physicians face a lack of evidence during their daily practice. In this report the authors address some of the difficult treatment decisions encountered in acute therapy and secondary prevention. Examples include off-label thrombolysis and prevention in high-risk situations. The available data from trials and registries are discussed, and personal views and recommendations are expressed.

Topics: Age Factors; Aged; Aged, 80 and over; Antihypertensive Agents; Atrial Fibrillation; Blood Glucose; Cerebral Hemorrhage; Clinical Trials as Topic; Diagnosis, Differential; Endarterectomy, Carotid; Epilepsy; Evidence-Based Medicine; Humans; Hypertension; International Normalized Ratio; Off-Label Use; Phenprocoumon; Platelet Aggregation Inhibitors; Registries; Risk Factors; Secondary Prevention; Stroke; Survival Analysis; Thrombolytic Therapy; Treatment Outcome

For patients who suffered a TIA or a stroke the risk of a second event is high. The recurrence rate, however, can be significantly reduced by a number of prophylactic strategies. Methods for secondary stroke prevention include a healthy lifestyle, intensive body exercise, a low cholesterol diet, and the cessation of smoking. High levels of blood pressure, cholesterol and blood glucose should be rigorously controlled. In particular, blood pressure levels should remain below 135/85 mmHg including a physiological day/night profile. All patients at high risk for cardiac embolism should receive oral anticoagulants. As the risk for embolic events increases with age (especially in patients with atrial fibrillation), a rigid "age-cutoff" for anticoagulation is not justified.

Topics: Administration, Oral; Adult; Anticholesteremic Agents; Anticoagulants; Antihypertensive Agents; Blood Coagulation Disorders; Brain Ischemia; Carotid Artery, Internal; Carotid Stenosis; Cerebral Infarction; Clinical Trials as Topic; Contraceptives, Oral; Embolism; Endarterectomy, Carotid; Exercise; Female; Humans; Hypertension; Hypolipidemic Agents; Ischemic Attack, Transient; Life Style; Male; Phenprocoumon; Platelet Aggregation Inhibitors; Recurrence; Simvastatin; Smoking Cessation; Stroke

To determine the frequency of essential cardiovascular risk factors in different vascular ocular diseases. -. We compiled cardiovascular risk factor findings (RFs) from 416 patients with non-inflammatory ocular vascular occlusions in a retrospective study: 134 patients with BRAO, 253 patients with CRAO, and 29 patients with hemi-CRAO. 274 (65.9 %) male and 142 (34.1 %) female patients were examined. Mean age of all patients was 66 years (range: 18-90). The right eye was involved in 221 (53.1 %), left eye in 193 (46.4 %), and both eyes in 2 patients (0.5 %). -. Cardiovascular risk factors (RFs) were found in 243 patients. Three hundred and eight (308) out of 406 patients (75.9 %) presented with arterial hypertension. Hypertension was present in 96 patients with BRAO (73.8 %), in 197 patients with CRAO (79.8 %), and in 15 patients with hemi-CRAO (78.9 %). - RFs such as arterial hypertension, carotid artery diseases, diabetes mellitus, hyperlipidemia, hyperuricemia, and chronic smoking did not differ statistically between patients with BRAO, CRAO or hemi--CRAO. But visible emboli in retinal arteries were observed in patients with BRAO (47 %,), or hemi-CRAO (41.4 %), much more often than in patients with CRAO (11.1 %). -. No statistical differences between the RFs of patients with BRAO, CRAO, or hemi-CRAO were noted. We maintain that every patient with retinal arterial obstruction should undergo extensive examination of essential RFs.

Topics: Adult; Aged; Aged, 80 and over; Amaurosis Fugax; Anticoagulants; Cardiovascular Diseases; Cerebrovascular Disorders; Female; Humans; Hypertension; Male; Middle Aged; Phenprocoumon; Retinal Artery Occlusion; Risk Factors