Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo, SP, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia, São Paulo, SP, Brazil.
Arq Neuropsiquiatr. 2022 May;80(5 Suppl 1):72-79. doi: 10.1590/0004-282X-ANP-2022-S132.
In 2019, the American Heart Association did not recommend the emergent use of anticoagulation to prevent recurrence or progression of acute ischemic stroke. However, its indication in patients with extracranial artery intraluminal thrombus with artery-to-artery cerebral embolization must be analyzed. In this article, we will also discuss other indications of anticoagulation. This treatment could be indicated in patients with ischemic stroke caused by embolization from cervical artery dissection, catastrophic antiphospholipid antibodies syndrome (APS) and some cases of Covid 19. For secondary prevention, anticoagulation is recommended for Cardioembolic stroke such as nonvalvular atrial fibrillation and other cardiopathies, some patients with cervical artery dissection, stroke associated with cancer, and thrombophilia such as APS. The timing to restart anticoagulation after a large ischemic stroke or after a cerebral hemorrhagic transformation always represent a challenge. Even in patients with high risk of thromboembolism it should be delayed at least two weeks, ideal after four weeks.
2019 年，美国心脏协会不建议将抗凝药物紧急用于预防急性缺血性脑卒中的复发或进展。然而，对于伴有动脉至动脉脑栓塞的颅外动脉腔内血栓形成的患者，必须分析其适应证。在本文中，我们还将讨论其他抗凝治疗的适应证。这种治疗方法可能适用于由颈动脉夹层、灾难性抗磷脂抗体综合征（APS）和某些 COVID-19 引起的栓塞性缺血性脑卒中患者。对于二级预防，建议对心源性栓塞性脑卒中（如非瓣膜性心房颤动和其他心脏病）、某些颈动脉夹层、与癌症相关的脑卒中以及 APS 等血栓形成倾向的患者进行抗凝治疗。在发生大面积缺血性脑卒中或脑出血转化后重新开始抗凝治疗的时机一直是一个挑战。即使对于血栓栓塞风险高的患者，也至少应延迟两周，理想情况下是四周后。
