Bousser M G
Service de Neurologie, Hĵpital Lariboisière, Paris, France.
Thromb Haemost. 2001 Jul;86(1):1-7.
Numerous randomised controlled trials have been devoted to antithrombotic strategy in stroke, thus making evidence-based recommendations possible. The use of antithrombotic drugs is crucial in the treatment of ischemic stroke though often limited by the inherent risk of intra-cerebral bleeding. In the prevention of stroke, the strategy depends on the underlying etiology: (i) antiplatelet drugs (with aspirin as first choice) in atherothrombotic stroke, and (ii) oral anticoagulants in cardioembolic stroke. In the acute treatment, the strategy depends on whether IV rt-PA can be performed; if rt-PA is available and approved, its use is recommended within 3 h of the onset of symptoms provided there is strict adherence to the inclusion and exclusion criteria. In all other cases, aspirin is the treatment of choice, associated with low dose LMWH in the event of restricted mobility. There is no evidence for efficacy of high dose heparin (or LMWH) in stroke, except in cerebral venous thrombosis.
许多随机对照试验致力于研究中风的抗血栓形成策略，从而使基于证据的建议成为可能。抗血栓药物在缺血性中风的治疗中至关重要，尽管其使用常常受到颅内出血固有风险的限制。在预防中风方面，策略取决于潜在病因：（i）在动脉粥样硬化血栓形成性中风中使用抗血小板药物（首选阿司匹林），以及（ii）在心源性栓塞性中风中使用口服抗凝剂。在急性治疗中，策略取决于是否可以进行静脉注射重组组织型纤溶酶原激活剂（IV rt-PA）；如果有rt-PA且已获批准，建议在症状发作后3小时内使用，前提是严格遵守纳入和排除标准。在所有其他情况下，阿司匹林是首选治疗药物，在行动不便的情况下可联合低剂量低分子肝素（LMWH）使用。除了脑静脉血栓形成外，没有证据表明高剂量肝素（或LMWH）对中风有效。
