The key to treating stroke tx is preventing the recurrence

Beware of side effects of bleeding

Park Jong-kyu, professor of neurology at Cheonan Hospital affiliated with Soonchunhyang University

Carefully use anticoagulants that can cause side effects of bleeding

Stroke is a battle against time.

 

Whether the blood vessels in the brain are blocked (brain infarction) or burst (brain hemorrhage), blood should be supplied to the brain normally within a short period of time.

 

The medical community explains that the golden time of stroke is 4.5 hours.

 

This means that the problem can be solved only when the symptoms occur and arrive at the hospital within 4 hours and 30 minutes.

 

The importance of preventive treatment has been increasing.

 

As the results of stroke treatment have improved compared to the past, drug treatment to prevent the recurrence of patients with stroke once has become more important.

 

Park Jong-kyu, a professor of neurology at Cheonan Hospital affiliated with Soonchunhyang University, said, "The key to treating stroke drugs is to prevent a recurrence," adding, "Various drugs are used differently depending on the cause.

 

Since the brain is a drug used in special areas, it should be used carefully in consideration of the side effects of bleeding, he said.

 

◆ Antiplatelet agents for vascular stroke and anticoagulants for embolic stroke There have been changes in the treatment of stroke over the past decade.

 

In the past, even if a stroke occurred, it often came late.

 

Many patients fell down holding the back of their necks and visited the emergency room.

 

As such, the treatment period has been delayed.

 

Major surgery was needed and the prognosis was not so good.

 

As public awareness of stroke has been aroused, treatment performance has improved significantly recently.

 

Unlike in the past, more and more patients visit the hospital due to initial symptoms, such as poor speech, narrow vision, and poor finger grip.

 

Treatment methods are also changing.

 

The importance of drug treatment is increasing as a secondary preventive treatment to prevent recurrence after treating an initial stroke.

 

Professor Park Jong-kyu said, "Depending on the cause of stroke, drugs are used differently," adding, "In the doctor's opinion, if it is a vascular stroke caused by blood clots accumulating in the cerebral blood vessels, an anticoagulant is used." Professor Park emphasized, "In the case of anticoagulants, it may look better to prevent the recurrence of stroke in that it prevents blood itself from coagulating, but it should be used carefully because there is a high risk of side effects of bleeding." ◆"Anticoagulants have a high risk of bleeding side effects, so they should be used carefully for stroke" According to Professor Park, anticoagulants are mainly used for patients suffering from arrhythmia or heart valve disease at the same time.

 

The problem is when heart disease is not clearly diagnosed.

 

In this case, the doctor's judgment is involved.

 

Professor Park explains, "Clinically, it seems that an embolized blood clot came from under the heart and blocked the cerebral blood vessels, but if there is not enough evidence." It is right to use antiplatelet drugs, but he explains that he uses anticoagulants on a limited basis because there is often a high risk of stroke recurrence.

 

Multiple cerebral infarctions, in which several blood vessels in the brain are blocked at the same time, are a typical example.

 

If the left blood vessel of the brain is observed to be blocked when the blood vessel of the brain is photographed, the cerebral infarction area should also be on the left side of the brain.

 

However, there are patients who often have cerebral infarction on the right side of the brain.

 

At this time, the location where the blood clot occurred is presumed to be below the heart, not the brain.

 

At this time, if the patient has no history of heart disease, the anticoagulant is used under the judgment of a doctor that the patient lacks the basis for anticoagulant treatment, but the risk of recurrence is high.

 

If multiple cerebral infarctions are not the first time, or if cerebral infarction occurs during recurrence prevention treatment with antiplatelet drugs, anticoagulants are used.

 

Professor Park said, "Most of the patient's risk factors and mechanisms for cerebral infarction are identified and drug treatment is carried out accordingly to prevent a recurrence." ◆ Stroke is the fourth leading cause of death in Korea, and the number of young patients is increasing recently Severe or acute stroke is still treated surgically.

 

Patients with blocked large blood vessels in the brain or blocked heavy blood vessels and poor symptoms are the targets.

 

The key is to treat it as soon as possible.

 

Generally, patients should visit the hospital within 4.5 hours.

 

Professor Park said, "Finding and operating blood vessels is only possible when large blood vessels are blocked.

 

In the case of heavy blood vessels and small blood vessels, surgery is attempted only when the symptoms are severe.

 

He said, "Because there is a risk to the treatment itself, we solve it with thrombolysis through veins instead of surgery." Professor Park explained, "It can be rather harmful to perform surgery after golden time." He added, "This is because the bleeding occurs in weak areas in the process of penetrating blood vessels and supplying blood again, which can be dangerous for patients." Stroke is the fourth most fatal disease in Korea.

 

According to the HIRA, 590,000 patients were diagnosed with stroke as of 2020.

 

The perception of stroke has changed and the number of patients is increasing faster as the population ages rapidly.

 

This is due to the increase in patients with hypertension and hyperlipidemia, which are the underlying diseases of stroke.

 

The medical community estimates that the incidence rate doubles every 10 years after the age of 55.

 

Professor Park explained, "As you get older, the risk factors you have are more likely to cause problems, so it will affect the increase in stroke." He said, "Recently, the number of young stroke patients under the age of 45 is increasing rapidly increasing.

 

"There are concerns as risk factors for stroke, such as sleep apnea, are diversifying," he said.