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SECONDARY PREVENTION ISCHEMIC STROKE IN YOUNG PEOPLE.
Rakhmatova Sanobar Nizamovna
Dzhumaev Bahodir Igamovich
Bukhoro davlat Tibbet institutes
https://orcid.org/0009-0009-5082-5450
https://doi.org/10.5281/zenodo.15426025
Relevance:
Cerebrovascular diseases occupy the second place in the
structure of mortality and the first place in the structure of primary disability. At
the same time, the proportion of ischemic strokes in the population is 80%, of
which 11-15% occur in young people. There are over 1 million people who have
suffered a stroke in the Russian Federation, and one third of them are people of
working age. Only 40% of young people with a diagnosed ischemic stroke return
to work.
The relevance of studying
the problem of stroke in young people is due to
the fact that its etiology in a significant proportion of patients differs from the
etiology of stroke in older age groups and often remains unclear, and this affects
secondary prevention; the algorithm for examining these patients has not been
sufficiently developed; the medical and social consequences are great. Among
young people with AI, over 40% return to work, which is associated with better
recovery of motor and speech functions compared with patients of older age
groups [2, 7]. In connection with the above aspects, a
number of studies are being conducted studying stroke in young people.
The most common classification in clinical practice is the etiopathogenetic
subtypes of AI (TOAST), let's consider some provisions [12, 15]:
1. Atherothrombotic stroke (due to atherosclerosis of large arteries,
including arterioarterial embolism). For this subtype of AI, the priority areas of
secondary prevention are reconstructive operations on the carotid arteries,
antiplatelet, lipid-lowering and hypotensive therapy.
2. Cardioembolic stroke (cardiac embolism).
Anticoagulant and antiarrhythmic therapy are preferred as secondary
prophylaxis.
3. Lacunar stroke (due to occlusion of small-caliber arteries).
Antihypertensive, antihyperglycemic, and antiplatelet therapy are prescribed as
secondary prophylaxis.
4. Stroke of another known etiology. Secondary prevention will be aimed at
correcting the identified causes of AI, for example, specific antithrombotic
therapy for coagulopathies or artery stenting during its dissection.
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5. Stroke of unknown etiology. Secondary prevention will be aimed at
correcting all identified vascular risk factors.
The aim of the study was to determine the features of secondary prevention
of ischemic stroke in young people.
Materials and methods.
We examined 10 patients (n = 10) with diagnosed
ischemic stroke aged 19 to 45 years (39 ± 9.24), of whom 5 were women and 5
were men. The age at the time of the stroke, gender, life history and illness were
assessed (attention was paid to the presence in the anamnesis
known risk factors for CVD and CVD and their primary prevention),
neurological status, clinical and instrumental examination and therapy in the
acute period, as well as prescribed secondary prevention.
Results.
Based on the data obtained, the following etiopathogenetic
subtypes of ischemic stroke were diagnosed in the study group: n = 5 (50%) – AI
of unknown etiology, n = 2 (20%) – AI of another known etiology, n = 2 (20%) –
AI lacunar, n = 1 (10%) – AI atherothrombotic. The group of patients with AI of
unknown etiology is predominantly represented (4 out of 5 examined patients)
by women.
Taking into account the pathological conditions and risk factors identified
in the examined patients, secondary prevention of CVD was prescribed: in 60%
of cases, aspirin was prescribed, in 30% double antithrombotic therapy (aspirin
+ dipyridamole, aspirin + warfarin, aspirin + clopidogrel), in 10% clopidogrel;
one patient (10%) underwent ICA stenting. In some cases, depending on the
identified risk factors, hypolipidemic, antihyperglycemic, antihypertensive,
antihyperuricemic therapy, diet and lifestyle modification are also
recommended.
Conclusions.
It makes sense for all young people with ischemic stroke to
search for possible pathology of the blood coagulation system, since the
incidence of abnormalities shown by screening studies is very high (40%). The
detected pathology of the blood coagulation system will change the secondary
prevention of cerebrovascular diseases, because, for example, insensitivity to
aspirin can be diagnosed, which is included in the standard of medical care and
is routinely prescribed as a secondary prevention in the form of monotherapy.
Prospective studies are needed to assess the correctness and completeness
of secondary prevention in young people with ischemic stroke.
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