Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine & Yale New Haven Hospital, 15 York Street, Building LLCI, 10thFloor Suite 1003, P.O. Box 20818, New Haven, CT, 06520, USA.
Curr Cardiol Rep. 2021 Oct 1;23(11):162. doi: 10.1007/s11886-021-01594-0.
Patients after intracerebral hemorrhage (ICH) are at high risk of both ischemic stroke and recurrent ICH, and stroke prevention after ICH is important to improve the long-term outcomes in this patient population. The objective of this article is to review the current guidelines on stroke prevention measures after ICH as well as the new findings and controversies for future guidance.
Intensive blood pressure reduction might benefit ICH survivors significantly. Cholesterol levels and the risk of ICH have an inverse relationship, but statin therapy after ICH might be still beneficial. Anticoagulation in atrial fibrillation after ICH specifically with novel oral anticoagulants may be associated with better long-term outcomes. Left atrial appendage occlusion may be an alternative for stroke prevention in ICH survivors with atrial fibrillation for whom long-term anticoagulation therapy is contraindicated. While complete individualized risk assessment is imperative to prevent stroke after ICH, future research is required to address current controversies and knowledge gap in this topic.
脑出血（ICH）患者发生缺血性卒中和再次ICH 的风险均较高，ICH 后预防卒中对于改善此类患者的长期预后非常重要。本文旨在综述目前关于 ICH 后卒中预防措施的指南，以及新的研究结果和争议，为未来的临床实践提供指导。
强化降压可能使 ICH 幸存者显著获益。胆固醇水平与 ICH 风险呈负相关，但 ICH 后他汀类药物治疗可能仍然有益。ICH 后心房颤动患者使用新型口服抗凝剂进行抗凝治疗可能与更好的长期预后相关。对于因长期抗凝治疗禁忌而不能接受抗凝治疗的 ICH 幸存者合并心房颤动患者，左心耳封堵术可能是预防卒中的一种替代方法。尽管全面的个体化风险评估对于预防 ICH 后卒中至关重要，但仍需要进一步的研究来解决这一领域的当前争议和知识空白。
