Department of Neurosurgery, UTHealth Neurosciences, McGovern School of Medicine, University of Texas Health Science Center, Houston, Texas.
Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Semin Neurol. 2021 Aug;41(4):365-387. doi: 10.1055/s-0041-1726331. Epub 2021 Apr 13.
Prevention of ischemic stroke relies on the use of antithrombotic medications comprising antiplatelet agents and anticoagulation. Stroke risk is particularly high in patients with cardiovascular disease. This review will focus on the role of antithrombotic therapies in the context of different types of cardiovascular disease. We will discuss oral antiplatelet medications and both IV and parental anticoagulants. Different kinds of cardiovascular disease contribute to stroke via distinct pathophysiological mechanisms, and the optimal treatment for each varies accordingly. We will explore the mechanism of stroke and evidence for antithrombotic therapy in the following conditions: atrial fibrillation, prosthetic heart values (mechanical and bioprosthetic), aortic arch atherosclerosis, congestive heart failure (CHF), endocarditis (infective and nonbacterial thrombotic endocarditis), patent foramen ovale (PFO), left ventricular assist devices (LVAD), and extracorporeal membrane oxygenation (ECMO). While robust data exist for antithrombotic use in conditions such as atrial fibrillation, optimal treatment in many situations remains under active investigation.
预防缺血性脑卒中依赖于使用抗血栓药物，包括抗血小板药物和抗凝药物。心血管疾病患者的卒中风险特别高。本篇综述将重点关注不同类型心血管疾病背景下抗血栓治疗的作用。我们将讨论口服抗血小板药物以及静脉和胃肠外抗凝药物。不同类型的心血管疾病通过不同的病理生理机制导致卒中，每种疾病的最佳治疗方法也因此而异。我们将探讨卒中的机制以及以下情况下抗血栓治疗的证据：心房颤动、人工心脏瓣膜（机械瓣和生物瓣）、主动脉弓粥样硬化、充血性心力衰竭（CHF）、心内膜炎（感染性和非细菌性血栓性心内膜炎）、卵圆孔未闭（PFO）、左心室辅助装置（LVAD）和体外膜氧合（ECMO）。尽管在心房颤动等情况下使用抗血栓药物有充分的数据，但在许多情况下的最佳治疗方法仍在积极研究中。
