METHOD FOR DETERMINING RISK OF OCCASIONAL CEREBRAL STROKE IN PATIENTS UNDERWENT CEREBROVASCULAR ACCIDENT

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely cardiology and neurology, and can be used to predict the risk of developing a repeated cerebral stroke (CS) in patients underwent a small ischemic stroke, ischemic CS, small hemorrhagic stroke, hemorrhagic CS. Not earlier than 60 days after the CS, in the early recovery period, after the selection of drug therapy in the outpatient monitoring phase of the patient, perform an anamnesis on the presence of concomitant diseases, an additional clinical diagnostic examination – ECG and daily Holter monitoring of the ECG, daily monitoring of blood pressure (BPM) or self-monitoring of blood pressure (BPSM), a biochemical blood test. Identify the presence/absence of arterial hypertension (AH), hyperlipidemia, diabetes mellitus (DM), auricular fibrillation and/or fluttering (AFib/AFlut). Perform an evaluation of the outpatient drug therapy with antihypertensive drugs (AHT) in patients with arterial hypertension (AH), lipid lowering drugs (LLT) in all patients underwent CS, oral anticoagulants (OAC) in patients with AFib/AFlut, disaggregants (DA) in all patients who underwent CS, without AFib/AFlut, sugar-lowering drugs – in patients with DM. Determine the effectiveness of antihypertensive therapy (AHT) for the target level of mean arterial pressure (AP) less than 140/90 mm Hg for patients without DM and less than 130/80 mm Hg – for patients with DM. Evaluation of the type of underwent CS is carried out: small ischemic stroke, ischemic CS, small hemorrhagic stroke, hemorrhagic CS. Patient adherence to the prescribed treatment is determined by the Morisky-Green test. Calculate the risk factor for occasional CS as C(OCSR)= (assigned(AHT+LLT+DA+OAC+DM)–(AHT effect.)+GAI)/(necessary (AHT+LLT+DA+OAC+HGT)+K(CS)), where the assigned – the sum of points for performed pharmacotherapeutic activities, necessary – the sum of the points for the activities that the patient needed to take in view of his/her anamnesis/concomitant diseases, AHT – 1 point value for performing antihypertensive therapy (AHT) in patients with elevated blood pressure, 0 point value for absence of prescription AHT, LLD – 1 point value for performing lipid-lowering therapy (LLT), 0 point value for not assigning, DA – 1 point value for the treatment of disaggregants in patients without auricular fibrillation and/or fluttering, for non-conductance 0 points, UAC – 1 point evaluation for oral anticoagulant therapy in patients with auricular fibrillation and/or fluttering, 0 point value for non-performance, HGT – 1 point value for the performing of hypoglycemic therapy (HGT) in patients with type 2 diabetes mellitus (DM), 0 point value for non-performance, AHT effect. – reaching/failure of target BP levels (reaching – 0 points, failure 0.5 points), GAI – the index of the general adherence of the patient to the prescribed treatment according to the Morisky-Green test (0.5 points for 0 or 1 positive response, -0.5 points with more than 2 positive responses), C(CS) is the reduction coefficient of CS (0 points for a small ischemic stroke, 1 point for all other cases of ischemic stroke and for a small hemorrhagic stroke, 2 points for all other cases of hemorrhagic stroke). At C(OCSR) value greater than or equal to 0.8, a low risk of occasional cerebrovascular accident (CVA) is predicted, with the value of C(OCSR) 0.51–0.79, the risk of occasional CVA is considered average, with a value of C(OCSR) of 0.21–0.5, the risk of occasional CVA is considered high and at a value of C(OCSR) less than or equal to 0.2 predict a very high risk of occasional CVA. Repeated evaluation of treatment is carried out once every three months, with a low and average risk of occasional CVA, once every two months, with a high and very high risk of occasional CVA within the first year after CS and once every six months – after 12 months after this event.;EFFECT: method provides an accurate assessment of the risk of developing a occasional CVA of any genesis by identifying a combination of the most important factors related to the prediction of the occasional CVA.;1 cl, 3 ex