Hart Robert G, Tonarelli Silvina B, Pearce Lesly A
Department of Medicine, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA.
Stroke. 2005 Jul;36(7):1588-93. doi: 10.1161/01.STR.0000170642.39876.f2. Epub 2005 Jun 9.
Approximately 7000 intracerebral hemorrhages (ICHs) annually in the US are caused by use of antithrombotic therapies. We review the incidence, risk factors, and predictors of ICH in patients receiving long-term anticoagulation or antiplatelet therapy.
ICH rates range from 0.3% to 0.6% per year during oral anticoagulation in recent reports. Major risk factors are advanced patient age, elevated blood pressure, intensity of anticoagulation, and previous cerebral ischemia. Combining antiplatelet agents with anticoagulation and the combined use of aspirin plus clopidogrel appear to increase ICH risk. Modest blood pressure-lowering halves the frequency of ICH during antiplatelet therapy.
ICH is an uncommon, but often fatal, complication of antithrombotic therapy that particularly afflicts patients with previous stroke. Recent data support that keeping international normalized ratio < or =3.0, control of hypertension, and avoiding the combination of aspirin with warfarin reduce its frequency.
在美国，每年约有7000例脑出血（ICH）是由抗栓治疗引起的。我们回顾了接受长期抗凝或抗血小板治疗的患者发生ICH的发生率、危险因素及预测因素。
近期报告显示，口服抗凝治疗期间，ICH的发生率为每年0.3%至0.6%。主要危险因素包括患者高龄、血压升高、抗凝强度及既往脑缺血。联合使用抗血小板药物与抗凝药物以及阿司匹林加氯吡格雷的联合使用似乎会增加ICH风险。适度降低血压可使抗血小板治疗期间ICH的发生率减半。
ICH是抗栓治疗中一种不常见但常致命的并发症，尤其困扰既往有卒中的患者。近期数据支持将国际标准化比值保持在≤3.0、控制高血压以及避免阿司匹林与华法林联合使用可降低其发生率。
