在急性缺血性脑卒中直接口服抗凝治疗中：溶栓治疗的安全性和预后改善的论证——从开始到结束。
Before, during, and after: An Argument for Safety and Improved Outcome of Thrombolysis in Acute Ischemic Stroke with Direct Oral Anticoagulant Treatment.
机构信息
Department of Neurology, Zilkha Neurogenetic Institute of the Keck School of Medicine, Los Angeles, CA, USA.
Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute of the Keck School of Medicine, Los Angeles, CA, USA.
出版信息
Ann Neurol. 2024 Nov;96(5):871-886. doi: 10.1002/ana.27058. Epub 2024 Sep 11.
Abstract
Direct oral anticoagulants are the primary stroke prevention option in patients with atrial fibrillation. Anticoagulant use before stroke, however, might inhibit clinician comfort with thrombolysis if a stroke does occur. Resuming anticoagulants after ischemic stroke is also problematic for fear of hemorrhage. We describe extensive literature showing that thrombolysis is safe after stroke with direct anticoagulant use. Early reinstitution of direct anticoagulant treatment is associated with lower risk of embolic recurrence and lower hemorrhage risk. The use of direct anticoagulants before, during, and after thrombolysis appears to be safe and is likely to promote improved outcomes after ischemic stroke. ANN NEUROL 2024;96:871-886.
摘要
直接口服抗凝剂是房颤患者预防中风的主要选择。然而，如果中风确实发生，抗凝剂的使用可能会抑制临床医生对溶栓的信心。由于担心出血，缺血性中风后重新使用抗凝剂也是一个问题。我们描述了大量文献，表明在使用直接抗凝剂后发生中风时溶栓是安全的。早期重新开始直接抗凝治疗与栓塞复发风险降低和出血风险降低相关。溶栓前、溶栓中和溶栓后使用直接抗凝剂似乎是安全的，并且可能会促进缺血性中风后的改善结局。ANN NEUROL 2024;96:871-886。
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