Mattle H P, Ringelstein E B
Neurologische Universitätsklinik, Inselspital, Bern.
Ther Umsch. 1996 Jul;53(7):573-84.
Two large randomized studies - NINDS and ECASS - have shown that fibrinolytics, when given early enough, reduce morbidity and mortality in acute stroke. The treatment has to be initiated within three hours after onset of symptoms. In middle cerebral artery stroke, fibrinolysis can be performed within six hours from onset, guided by computed tomography criteria. Thereafter, s.c. low-molecular-weight heparin can still improve the fate of the patient. Currently, the potential benefit or harm of unfractionated heparin and aspirin is not yet known. However, large-scale studies using standard heparin, aspirin of low-molecular-weight heparin are in progress with results expected soon. After the acute stage of stroke, risk factors have to be eliminated or modified, and anticoagulants, platelet inhibitors and, in selected cases, carotid endarterectomy are useful in preventing recurrent stroke or other vascular events.
两项大型随机研究——美国国立神经疾病与中风研究所（NINDS）的研究和欧洲急性卒中协作研究（ECASS）——表明，纤溶药物若给予足够早，可降低急性卒中的发病率和死亡率。治疗必须在症状出现后的三小时内开始。对于大脑中动脉卒中，在计算机断层扫描标准的指导下，可在症状出现后的六小时内进行纤溶治疗。此后，皮下注射低分子量肝素仍可改善患者的预后。目前，普通肝素和阿司匹林的潜在益处或危害尚不清楚。然而，使用标准肝素、阿司匹林或低分子量肝素的大规模研究正在进行中，预计很快会有结果。在卒中急性期过后，必须消除或改善危险因素，抗凝剂、血小板抑制剂，以及在某些特定情况下的颈动脉内膜切除术，对于预防复发性卒中或其他血管事件是有用的。
