Abstract
Stroke has traditionally been classified according to the trial of ORG 10172 in acute stroke treatment (TOAST) criteria; however, the concept of cryptogenic stroke did not meet the operational criteria necessary to define patient populations eligible for randomized studies. Therefore, the concept of embolic stroke of undetermined etiology (ESUS) was developed. An underlying hypothesis was that most strokes in patients with ESUS are caused by embolic events, hence, anticoagulation may prevent secondary events. Therefore, two large randomized trials were conducted comparing dabigatran or rivaroxaban with acetylsalicylic acid. Both studies could not show superiority of the new oral anticoagulants (NOAC) compared to aspirin; however, subgroup analyses showed that there is apatient population that may benefit from oral anticoagulation.
Highlights
Eine Reihe von Studien untersuchte EKG- und echokardiographische Parameter, um Schlaganfälle bei Patienten mit ESUS vorauszusagen
Stroke has traditionally been classified according to the trial of ORG 10172 in acute stroke treatment (TOAST) criteria; the concept of cryptogenic stroke did not meet the operational criteria necessary to define patient populations eligible for randomized studies
An underlying hypothesis was that most strokes in patients with ESUS are caused by embolic events, anticoagulation may prevent secondary events
Summary
Die Klassifikation ischämischer Schlaganfälle erfolgt traditionell nach den TOAST-Kriterien [1]. Die zugrunde liegende Hypothese von ESUS war, dass die meisten Schlaganfälle bei diesen Patienten durch embolische Mechanismen bedingt sind [2]. Zur Überprüfung der Hypothese, ob orale Nicht-Vitamin-K-Antikoagulanzien (NOAKs) bei Patienten mit ESUS wirksamer sind als Thrombozytenfunktionshemmer wie Acetylsalicylsäure (Aspirin), wurden zwei große randomisierte Studien durchgeführt, nämlich RE-SPECT ESUS (Randomized, DoubleBlind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate versus Acetylsalicylic Acid in Patients with Embolic Stroke of Undetermined Source; [8, 9]) und NAVIGATE ESUS (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source; [10, 11]).
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