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

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.

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