Purrucker Jan C, Steiner Thorsten
aDepartment of Neurology, Heidelberg University Hospital, Heidelberg bDepartment of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany.
Curr Opin Neurol. 2017 Feb;30(1):1-7. doi: 10.1097/WCO.0000000000000406.
An increasing number of patients are receiving oral anticoagulants. Since non-vitamin K antagonist oral anticoagulants (NOACs) were approved, primary prevention of ischemic stroke has become simpler. However, managing ischemic stroke and intracerebral hemorrhage while on oral anticoagulation (OAC) has become more complex. This review covers the latest developments in managing ischemic and hemorrhagic stroke in patients receiving vitamin K antagonists (VKA) and NOACs.
Testing coagulation in patients with acute ischemic stroke and receiving NOACs is complex, and observational data challenge guideline recommendations. Initial registry and cohort data support the safety of endovascular therapy despite OAC. In intracerebral hemorrhage, rapid reversal of VKA can be achieved better with prothrombin complex concentrates than with fresh frozen plasma. Furthermore, rapid reversal seems to be associated with less hematoma expansion and better functional outcome. In addition, new evidence strongly supports resuming OAC after intracerebral hemorrhage. The unfavorable properties of NOAC-related intracerebral hemorrhage are similar to those associated with VKA.
Translation of recent findings might improve both outcome in acute ischemic and hemorrhagic stroke in patients on oral anticoagulants and help refine clinical management. Data from randomized clinical trials are scarce.
越来越多的患者正在接受口服抗凝剂治疗。自从非维生素K拮抗剂口服抗凝剂（NOACs）获批以来，缺血性卒中的一级预防变得更加简单。然而，在口服抗凝治疗（OAC）期间管理缺血性卒中和脑出血变得更加复杂。本综述涵盖了接受维生素K拮抗剂（VKA）和NOACs治疗的患者中缺血性和出血性卒中管理的最新进展。
对急性缺血性卒中且正在接受NOACs治疗的患者进行凝血检测很复杂，观察性数据对指南建议提出了挑战。尽管进行了OAC治疗，但初始登记和队列数据支持血管内治疗的安全性。在脑出血方面，与新鲜冰冻血浆相比，凝血酶原复合物浓缩剂能更好地实现VKA的快速逆转。此外，快速逆转似乎与血肿扩大减少和更好的功能结局相关。此外，新证据强烈支持脑出血后恢复OAC治疗。NOAC相关脑出血的不良特性与VKA相关的类似。
对最新发现的转化可能会改善口服抗凝剂治疗患者急性缺血性和出血性卒中的结局，并有助于优化临床管理。随机临床试验的数据很少。
