CURRENT AND FUTURE-OPTIONS FOR THE PREVENTION AND TREATMENT OF STROKE

At present, no drug has been proven to be effective in the treatment o f acute ischaemic stroke or intraparenchymatous haemorrhage. However, investigations of neuroprotective, antiplatelet, anticoagulation and t hrombolytic therapies for acute ischaemic stroke are ongoing. Recent s tudies have provided evidence of the usefulness of therapies for the p rimary and secondary prevention of ischaemic stroke. In the primary pr evention of ischaemic stroke, warfarin is indicated in all patients wi th atrial fibrillation and at least 1 risk factor for stroke, and for patients greater than 65 years old with lone atrial fibrillation. Warf arin is also indicated for the secondary prevention of ischaemic strok e in patients with atrial fibrillation. Aspirin (acetylsalicylic acid) and ticlopidine are indicated for the secondary prevention of ischaem ic stroke in patients without atrial fibrillation. Carotid endarterect omy is beneficial in patients with high grade stenosis and transient i schaemic attacks or nondisabling stroke. In patients with subarachnoid haemorrhage, the prevention of rebleeding is based on surgical interv ention; however, nimodipine is useful in preventing the incidence of d elayed cerebral ischaemia.