Experience of the use of dipyridamole for secondary prevention of ischemic stroke

Abstract

Acute cerebrovascular accident (ACV) is an important medical and social problem, which is associated with high morbidity, mortality and frequent disability. The current system for providing specialized medical care to patients with stroke has shown its effectiveness, as evidenced by a decrease in hospital mortality and an increase in the number of patients returning to work. However, the incidence of stroke remains high, which is also associated with the COVID-19 pandemic. Every third patient with COVID-19 had neurological symptoms, and a pathomorphological study of the brain of the deceased showed signs of hypoxic encephalopathy in every fifth. Due to the fact that with COVID-19 there is a high probability of developing ischemic stroke (IS), it is necessary to promptly identify and correct the following factors that contribute to the occurrence of stroke with COVID-19: cardiovascular diseases, diabetes mellitus, arterial hypertension, atherosclerosis. Direct exposure to the virus results in systemic inflammatory hyperactivity with a prothrombotic state secondary to protein C and S deficiency. An important problem is both the prevention of the first and recurrent stroke, regardless of the etiology. The basis of secondary prevention is the correction of risk factors, as well as the development of an individual program with antihypertensive, lipid-lowering therapy. The leading line of secondary prevention of IS is antiplatelet therapy, which reduces the risk of developing acute vascular episodes by 25%. For the purpose of secondary prevention of ischemic stroke, acetylsalicylic acid, dipyridamole, clopidogrel are used. In the discussed clinical observation, a patient developed repeated episodes of transient ischemic attack against the background of a stenosing process in the common carotid artery, hypertension, and a previous coronavirus infection. Given that the greatest risk of recurrent stroke is associated with atherosclerosis, which can be complicated by thrombus formation, chimes and acetylsalicylic acid were chosen for secondary prevention. Follow-up observation showed the correctness of the chosen tactics.