New Findings in Stroke Prevention and Treatment

Based on selected publications from the past 12 months, current developments and innovations in the prevention and treatment of stroke are presented. The direct thrombin inhibitor dabigatran is superior to warfarin with a lower risk of intracranial bleeding complications and has been approved in patients with atrial fibrillation since August 2011. Other new generation oral anticoagulants like rivaroxaban and apixaban also are superior to warfarin but have not yet been approved in Europe in patients with atrial fibrillation. Aggressive antidiabetic treatment is associated with fewer microvascular complications but does not reduce the risk of stroke, cardiovascular events or mortality. The risk of recurrent stroke increases by 40% after stopping antiplatelet therapy. Extension of the time-window for systemic thrombolysis from 3 to 4.5 h did not result in higher rates of bleeding complications or mortality, and admission-to-treatment time did not increase. Age >80 years alone should not be a barrier to treatment with thrombolysis. Angiotensin receptor blockers do not improve functional outcome and neither reduce cognitive impairment after stroke nor the risk of cardio- or cerebrovascular events in patients with atrial fibrillation. Surgical treatment is preferable to stenting for treatment of symptomatic high-grade carotid stenosis. Stenting of intracranial stenoses or asymptomatic extracranial stenoses is rather not recommended. Early administration of low molecular weight heparins for prophylaxis of thromboembolism and resumption of oral anticoagulation 10-30 weeks after intracerebral haemorrhage are probably safe. Advanced CT imaging is sufficiently reliable in detecting subarachnoid haemorhage and intracranial aneurysms. Endothelin receptor antagonists are not effective for the treatment of vasospasm.