ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 27 of 58
JMBS 2020, 5(6): 188–194
Clinical Medicine

Effectiveness of Antiviral Therapy in the Secondary Prevention of the Ischemic Stroke on the Background of Viral Infection Manifestation

Turchina N., Cherenko T.

Recurrent stroke remains the key health issue in the world. A higher three-year recurrence rate of stroke in patients with persistence of the genome of herpes viruses, and with presence in the blood of the genome of at least 2 types of viruses was identified. These investigations demonstrate the importance of further research into the role of antiviral therapy in improving the rehabilitation and secondary prevention of stroke in patients with persistent viral infection The purpose of the study was to evaluate the effectiveness of antiviral therapy in the secondary ischemic stroke prevention on the viral infection manifestation background. Material and methods. The study included 105 patients with moderate to severe ischemic stroke with a viral manifestation confirmed by the detection of herpes virus’s DNA (HSV1, HSV2, EBV, CMV, HHV6) and Flu RNA. Patients who were additionally prescribed antiviral drugs on the background of traditional therapy were in the main group (n = 35). Patients who received only traditional, recommended by the modern stroke treatment guidelines, therapy and secondary stroke prevention measures were included in the comparison group (n = 70). Results and discussion. We found that the effectiveness of the proposed preventive treatment depended on the viral load of the patient. In the presence of three or more types of viruses, the proposed therapy provided a significantly lower ischemic stroke recurrence rate, compared to the patients who did not receive antiviral therapy 11.1% vs. 49.8%, p = 0.042. Prevention of recurrent ischemic stroke, which should have started as soon as possible after the development of the first stroke or transient ischemic attack occurrence, F. Rincon and R. L. Sacco (2008) consider the most relevant in this group of patients. Herewith, as emphasized by D. G. Hackam and J. D. Spence (2007), comprehensive prevention has reduced the risk of recurrent ischemic stroke by almost 80%, thus preventing 4 out of 5 possible disorders. However, both native and world literature still has a lack of systematic data of the problem of antiviral therapy using in patients with acute disorders of cerebral circulation, although it has been proven that infectious and inflammatory complications are an important pathogenetic factor of its unfavorable and severe outcome. M. S. Elkind et al. (2016) consider that antiviral drugs such as acyclovir may play an appropriate role in the prevention of recurrent ischemic stroke in children if their causal relation is confirmed. Conclusion. The use of acyclovir in complex rehabilitation therapy and secondary stroke prevention in patients with viral infection manifestation provided an increase in the average score of Bartel index after 1 year, p = 0.017. In the case of antiviral therapy using in the complex prevention of recurrent vascular events in patients with viral infection manifestation, the three-year recurrence rate of stroke is lower (p = 0.042)

Keywords: ischemic stroke, recurrences, viruses, secondary prevention, antiviral therapy

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  1. Redfors P, Jood K, Holmegaard L, Rosengren A, Blomstrand C, Jern C. Stroke subtype predicts outcome in young and middle-aged stroke sufferers. Acta Neurol Scand. 2012; 126: 329-335.
  2. Allen NB, Holford TR, Bracken MB, Goldstein LB, Howard G, Wang Y, et al. Trends in one-year recurrent ischemic stroke among the elderly in the USA: 1994-2002. Cerebrovasc Dis. 2010; 30: 525-32.
  3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al.; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26; 133(4): e38-360.
  4. Hillen T, Coshall C, Tilling K, Rudd AG, McGovern R, Wolfe CD; South London Stroke Register. Cause of stroke recurrence is multifactorial: patterns, risk factors, and outcomes of stroke recurrence in the South London Stroke Register. Stroke. 2003 Jun; 34(6): 1457-63.
  5. Clery A, Bhalla A, Bisquera A, Skolarus LE, Marshall I, McKevitt C, et al. Long-term trends in stroke survivors discharged to care homes: The South London Stroke Register. Stroke. 2020 Jan; 51(1): 179-85.
  6. Flach C, Muruet W, Wolfe CDA, Bhalla A, Douiri A. Risk and secondary prevention of stroke recurrence: A Population-Base Cohort Study. Stroke. 2020 Aug; 51(8): 2435-44.
  7. Buenaflor FGB, Navarro JC, Lara KJA, Venketasubramanian N. Recurrence Rate of Ischemic Stroke: A Single Center Experience. Austin J Cerebrovasc Dis Stroke. 2017; 4(2): 1057.
  8. Lee BI, Nam HS, Heo JH, Kim DI; Yonsei Stroke Team. Yonsei Stroke Registry. Analysis of 1,000 patients with acute cerebral infarctions. Cerebrovasc Dis. 2001; 12(3): 145-51.
  9. Feng W, Hendry RM, Adams RJ. Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients. Neurology. 2010; 74: 588-93.
  10. Forbes ID, Harriet J, Williamson E, Breuer J, Brown MM, Langan SM, at al. Association of herpesviruses and stroke: Systematic review and meta-analysis. PLoS One. 2018 Nov 21; 13(11): e0206163.
  11. Turchyna NS, Cherenko TM. Ryzyk tryrichnoho retsydyvu ishemichnoho insultu ta yoho nezalezhni predyktory u khvorykh z pidtverdzhenoiu manifestnoiu virusnoiu infektsiieiu [The risk of three-year recurrence of ischemic stroke and its undesirable predictors in patients with confirmed overt viral infection]. Ukr nevrol zhurn. 2020; (3): 15-22. [Ukrainian]
  12. Odderson IR. The National Institutes of Health Stroke Scale and its importance in acute stroke management. Phys Med Rehabil Clin N Am. 1999: 10(4): 787-800.
  13. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md state Med J. 1965 Feb; 14: 61-5.
  14. Turchyna NS, Cherenko TM, Тrepet LN, Rebаlkо SL, Stаrоsylа DB. Chаstоtа viyavlеnnya pidtverdzhenoiu manifestnoiu virusnoiu infektsiieiu u khvоrykh z ishemichnum insultom v zаlежzhnоstі vіd sеzоnu roku [Effectiveness of Antiviral Therapy in the Secondary Prevention of the Ischemic Stroke on the Background of Viral Infection Manifestation]. Medical science of Ukraine. 2020; 16(4): 10-16.
  15. Jönsson AC, Delavaran H, Lövkvist H, Baturova M, Iwarsson S, Ståhl A, et al. Secondary prevention and lifestyle indices after stroke in a long-term perspective. Acta Neurol Scand. 2018 Sep; 138(3): 227-34.
  16. John S, Katzan I. Recurrent stroke while on antiplatelet therapy. Neurol Clin. 2015 May; 33(2): 475-89.
  17. Gorelick PB. Prevention of stroke recurrence. Int Psychogeriatr. 2003; 15(Suppl 1): 167-71.
  18. Bursztyn M. Vascular events after acute infection or vaccination. N Engl J Med. 2005 Mar 17; 352(11): 1151-3.
  19. Grau AJ. Role of anti-infective strategies in the prevention of stroke. Curr Treat Options Cardiovasc Med. 2005 Jul; 7(3): 187-95.
  20. Rincon F, Sacco RL. Secondary stroke prevention. J Cardiovasc Nurs. 2008 Jan-Feb; 23(1): 34-41.
  21. Hackam DG, Spence JD. Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study. Stroke. 2007 Jun; 38(6): 1881-5.
  22. Miller EC, Elkind MS. Infection and stroke: an update on recent progress. Curr Neurol Neurosci Rep. 2016 Jan; 16(1): 2.
  23. Huang HI, Shih SR. Neurotropic enterovirus infections in the central nervous system. Viruses. 2015 Nov 24; 7(11): 6051-66.
  24. Elkind MS, Hills NK, Glaser CA, Lo WD, Amlie-Lefond C, Dlamini N, et al. Herpesvirus infections and childhood arterial ischemic stroke: results of the VIPS study. Circulation. 2016 Feb 23; 133(8): 732-41.