da Silva Ivan Rocha Ferreira, Frontera Jennifer A
From the Department of Neurological Sciences, Rush University Medical Center (IRFS), Chicago, IL, USA.
Department of Neurology, NYU School of Medicine, 150 55th St. Suite 3516, Brooklyn, NY, 11231, USA.
Curr Treat Options Neurol. 2017 Sep 30;19(11):39. doi: 10.1007/s11940-017-0477-y.
Anticoagulation is a vital therapy in a number of different disease processes, and is strongly recommended for the prevention of stroke in patients with atrial fibrillation and/or with mechanical prosthetic heart valves. Studies involving patients on oral anticoagulants (OACs) have revealed that ICH can occur eight times more frequently in this population, with an annual estimated incidence of 0.25 to 1.1%. The decision of whether and when to resume anticoagulation following intracranial hemorrhage is challenging and requires an assessment of associated risks and benefits. Clinical data, imaging, and risk factors for both ischemic and hemorrhagic complications may aid in decision-making. Baseline functional status, life expectancy, compliance with therapy, and family support also impact decision analyses. Currently available data suggest that anticoagulation could be safely restarted in select groups of OAC-ICH patients within 4 weeks of intracranial hemorrhage; however, high-quality randomized, clinical trials are needed.
抗凝治疗在许多不同的疾病过程中都是至关重要的治疗方法，强烈推荐用于预防心房颤动和/或机械人工心脏瓣膜患者的中风。涉及口服抗凝剂（OAC）患者的研究表明，该人群颅内出血（ICH）的发生率可能高出八倍，估计年发生率为0.25%至1.1%。颅内出血后是否以及何时恢复抗凝治疗的决策具有挑战性，需要评估相关的风险和益处。缺血性和出血性并发症的临床数据、影像学检查以及风险因素可能有助于决策。基线功能状态、预期寿命、治疗依从性和家庭支持也会影响决策分析。目前可得的数据表明，部分口服抗凝剂相关颅内出血（OAC-ICH）患者在颅内出血后4周内可以安全地重新开始抗凝治疗；然而，仍需要高质量的随机临床试验。
