Cai Qiyan, Zhang Xin, Chen Hong
Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
Respiratory Disease Department, Xinqiao Hospital, Chongqing, China.
Thromb J. 2021 Nov 27;19(1):93. doi: 10.1186/s12959-021-00345-z.
Patients with spontaneous intracerebral hemorrhage (ICH) have a higher risk of venous thromboembolism (VTE) and in-hospital VTE is independently associated with poor outcomes for this patient population.
A comprehensive literature search about patients with VTE after spontaneous ICH was conducted using databases MEDLINE and PubMed. We searched for the following terms and other related terms (in US and UK spelling) to identify relevant studies: intracerebral hemorrhage, ICH, intraparenchymal hemorrhage, IPH, venous thromboembolism, VTE, deep vein thrombosis, DVT, pulmonary embolism, and PE. The search was restricted to human subjects and limited to articles published in English. Abstracts were screened and data from potentially relevant articles was analyzed.
The prophylaxis and treatment of VTE are of vital importance for patients with spontaneous ICH. Prophylaxis measures can be mainly categorized into mechanical prophylaxis and chemoprophylaxis. Treatment strategies include anticoagulation, vena cava filter, systemic thrombolytic therapy, catheter-based thrombus removal, and surgical embolectomy. We briefly summarized the state of knowledge regarding the prophylaxis measures and treatment strategies of VTE after spontaneous ICH in this review, especially on chemoprophylaxis and anticoagulation therapy. Early mechanical prophylaxis, especially with intermittent pneumatic compression, is recommended by recent guidelines for patients with spontaneous ICH. While decision-making on chemoprophylaxis and anticoagulation therapy evokes debate among clinicians, because of the concern that anticoagulants may increase the risk of recurrent ICH and hematoma expansion. Uncertainty still exists regarding optimal anticoagulants, the timing of initiation, and dosage.
Based on current evidence, we deem that initiating chemoprophylaxis with UFH/LMWH within 24-48 h of ICH onset could be safe; anticoagulation therapy should depend on individual clinical condition; the role of NOACs in this patient population could be promising.
自发性脑出血（ICH）患者发生静脉血栓栓塞（VTE）的风险较高，且院内VTE与该患者群体的不良预后独立相关。
使用MEDLINE和PubMed数据库对自发性ICH后发生VTE的患者进行了全面的文献检索。我们搜索了以下术语及其他相关术语（美式和英式拼写）以识别相关研究：脑出血、ICH、脑实质内出血、IPH、静脉血栓栓塞、VTE、深静脉血栓形成、DVT、肺栓塞和PE。检索仅限于人类受试者，且仅限于英文发表的文章。筛选摘要并分析潜在相关文章的数据。
VTE的预防和治疗对自发性ICH患者至关重要。预防措施主要可分为机械预防和化学预防。治疗策略包括抗凝、腔静脉滤器、全身溶栓治疗、基于导管的血栓清除和手术取栓。在本综述中，我们简要总结了自发性ICH后VTE预防措施和治疗策略的知识现状，特别是化学预防和抗凝治疗方面。近期指南建议对自发性ICH患者尽早进行机械预防，尤其是采用间歇性气动压迫。虽然化学预防和抗凝治疗的决策在临床医生中引发了争论，因为担心抗凝剂可能增加ICH复发和血肿扩大的风险。关于最佳抗凝剂、开始时间和剂量仍存在不确定性。
基于目前的证据，我们认为在ICH发作后24 - 48小时内开始使用普通肝素/低分子肝素进行化学预防可能是安全的；抗凝治疗应取决于个体临床情况；新型口服抗凝药在该患者群体中的作用可能很有前景。
