Department of Neurosurgery, Centre Hospitalier de Wallonie picarde - CHwapi A.S.B.L., Site UNION, Tournai, Belgium.
Department of Cardiology, General Hospital of Athens "G. Gennimatas", Athens, Greece.
J Popul Ther Clin Pharmacol. 2020 Apr 3;27(2):e1-e18. doi: 10.15586/jptcp.v27i2.660.
Intracerebral hemorrhage (ICH)1 is characterized by the pathological accumulation of blood within the brain parenchyma, most commonly associated with hypertension, arteriovenous malformations, or trauma. However, it can also present in patients receiving antithrombotic drugs, either anticoagulants such as acenocoumarol/warfarin-novel oral anticoagulants or antiplatelets, for the prevention and treatment of thromboembolic disease.
The purpose of this review is to present current bibliographic data regarding ICH irrespective of the cause, as well as post-hemorrhage use of antithrombotic agents. Moreover, this review attempts to provide guidelines concerning the termination, inversion, and of course resumption of antithrombotic therapy.
We reviewed the most recently presented available data for patients who dealt with intracerebral hemorrhagic events while on antithrombotic agents (due to atrial fibrillation, prosthetic mechanical valves or recent/recurrent deep vein thrombosis). Furthermore, we examined and compared the thromboembolic risk, the bleeding risk, as well as the re-bleeding risk in two groups: patients receiving antithrombotic therapy versus patients not on antithrombotic therapy.
Antithrombotic therapy is of great importance when indicated, though it does not come without crucial side-effects, such as ICH. Optimal timing of withdrawal, reversal, and resumption of antithrombotic treatment should be determined by a multidisciplinary team consisting of a stroke specialist, a cardiologist, and a neurosurgeon, who will individually approach the needs and risks of each patient.
脑出血 (ICH) 1 的特征是病理性血液在脑实质内积聚，最常见于高血压、动静脉畸形或创伤。然而，它也可能出现在接受抗血栓药物治疗的患者中，这些药物包括抗凝剂（如醋硝香豆素/华法林-新型口服抗凝剂）或抗血小板药物，用于预防和治疗血栓栓塞性疾病。
本综述旨在介绍目前与脑出血无关的病因以及出血后使用抗血栓药物的相关文献数据。此外，本综述试图提供关于抗血栓治疗的终止、反转以及当然是恢复的指南。
我们回顾了最近报道的接受抗血栓药物治疗的脑出血患者（因心房颤动、人工机械瓣膜或近期/复发性深静脉血栓形成）的数据。此外，我们比较了两组患者的血栓栓塞风险、出血风险和再出血风险：接受抗血栓治疗的患者和未接受抗血栓治疗的患者。
抗血栓治疗在指征明确时非常重要，但也存在重要的副作用，如脑出血。抗血栓治疗的最佳停药、逆转和恢复时间应由一个由中风专家、心脏病专家和神经外科医生组成的多学科团队确定，他们将根据每位患者的需求和风险单独处理。
