Medicines Monitoring Unit (MEMO), Division of Medical Sciences, University of Dundee, Dundee, Scotland, UK.
Cardiovasc Ther. 2010 Jun;28(3):177-84. doi: 10.1111/j.1755-5922.2009.00118.x. Epub 2010 Mar 7.
Patients with intracerebral hemorrhage frequently have indications for antithrombotic therapy. This represents a therapeutic dilemma as intracerebral hemorrhage is considered a contraindication to antithrombotic medication. Previous systematic reviews have revealed no long-term randomised studies addressing this issue. Our objective was to review observational studies describing the long-term follow-up of patients receiving antithrombotic therapy following intracerebral hemorrhage. Searches were conducted in MEDLINE and EMBASE from 1984 to 2008 for any observational studies detailing use of antithrombotic treatments in patients with intracerebral hemorrhage. Included studies must have had follow-up extending beyond discharge. The primary endpoint was recurrent intracerebral hemorrhage. Secondary endpoints were ischemic events and serious vascular events. 1,301 articles were reviewed: two epidemiological studies and six case series met the inclusion criteria. These described a total of 46 subjects receiving antiplatelet agents (from one study) and 42 patients receiving oral anticoagulants (from one study and six case-series). For patients receiving subsequent aspirin there were seven recurrent intracerebral hemorrhages and four subsequent thrombo-occulsive events. Amongst patients restarting oral anticoagulation there were four recurrent intracerebral bleeds and nine subsequent thrombo-occulsive events. There is a marked paucity of evidence to guide clinicians when planning the long-term management of patients with intracerebral hemorrhage and cogent indications for antithrombotic therapy. Published guidance addressing this issue is not evidence based. In the continued absence of randomised studies addressing antithrombotic use following intracerebral hemorrhage, there is a clear requirement for further high quality observational data on the clinical impact of antithrombotic therapy in this important patient group.
脑出血患者常需要进行抗血栓治疗。这是一个治疗难题，因为脑出血被认为是抗血栓药物治疗的禁忌证。先前的系统综述并未发现有长期的随机研究来解决这个问题。我们的目的是综述描述脑出血后接受抗血栓治疗的患者长期随访情况的观察性研究。我们在 MEDLINE 和 EMBASE 中进行了从 1984 年至 2008 年的检索，以寻找任何详细描述脑出血患者使用抗血栓治疗的观察性研究。纳入的研究必须有随访时间超过出院时间。主要终点是复发性脑出血。次要终点是缺血性事件和严重血管事件。共检索到 1301 篇文章：两项流行病学研究和六项病例系列研究符合纳入标准。这些研究共描述了 46 例接受抗血小板药物（一项研究）和 42 例接受口服抗凝剂（一项研究和六项病例系列研究）的患者。在接受后续阿司匹林治疗的患者中，有 7 例复发性脑出血和 4 例随后发生血栓栓塞事件。在重新开始口服抗凝治疗的患者中，有 4 例复发性脑出血和 9 例随后发生血栓栓塞事件。目前几乎没有证据可以指导临床医生在计划脑出血患者的长期治疗时使用抗血栓治疗，而抗血栓治疗的明确适应证仍然存在。目前针对该问题的已发表指南并没有依据。在继续缺乏解决脑出血后抗血栓治疗问题的随机研究的情况下，明确需要进一步开展高质量的观察性数据研究，以评估抗血栓治疗对这一重要患者群体的临床影响。
