van den Berg E, Lohmann N, Friedburg D, Rabe F
Medical Department I, Krefeld Hospital.
Vasa. 1997 Aug;26(3):222-7.
Recurrent thrombo-embolism represents by far the commonest cause of cerebral and retinal ischaemia. In an open clinical study, experience with a largely general anticoagulation in the acute phase of cerebral and retinal ischaemia is reported.
From October 1993 to October 1996, 781 patients with acute cerebral ischaemia were admitted to the medical emergency ward. Taking contra-indications into consideration and after CT exclusion of cerebral haemorrhage (2%). Immediate therapeutic heparinisation (1.5-2-fold prolongation of aPTT) was administered to 664 patients (85%) over 7-10 days. In a concurrent Doppler/duplex comparative study, 143 patients with retinal artery occlusion were investigated for the prevalence of potential sources of emboli in the region of the extracranial carotids and internal carotid circulation respectively. 108 patients served as a reference group whose acute loss of vision of vascular origin could be attributed to retinal vein thrombosis.
The complication rate of anticoagulation in acute cerebral ischaemia was 0.8% (major complications), and the recurrence rate during the period of treatment was 2.4%. In 131 patients with acute retinal ischaemia, therapeutic heparinisation was performed without ocular cerebral or extracerebral complications. Potential ipsilateral sources of emboli (highgrade carotid stenosis or complex plaques with thrombotic deposits) were found in 55%, but in only 7% of the control group (p < 0.0001).
Immediate anticoagulation in the form of aPTT-monitored therapeutic heparinisation represents a rational and low-risk concept for the treatment of acute cerebral and retinal ischaemia.
复发性血栓栓塞是迄今为止脑缺血和视网膜缺血最常见的病因。本文报告了一项开放性临床研究中，在脑缺血和视网膜缺血急性期进行广泛普通抗凝治疗的经验。
1993年10月至1996年10月，781例急性脑缺血患者入住急诊病房。考虑到禁忌证，并经CT排除脑出血（2%）后，664例患者（85%）接受了7 - 10天的即刻治疗性肝素化（活化部分凝血活酶时间延长1.5 - 2倍）。在一项同期的多普勒/双功超声对比研究中，分别对143例视网膜动脉阻塞患者颅外颈动脉区域和颈内动脉循环中潜在栓子来源的患病率进行了调查。108例患者作为参照组，其急性血管性视力丧失可归因于视网膜静脉血栓形成。
急性脑缺血抗凝治疗的并发症发生率为0.8%（主要并发症），治疗期间的复发率为2.4%。131例急性视网膜缺血患者进行了治疗性肝素化，未出现眼部、脑部或脑外并发症。55%的患者发现同侧潜在栓子来源（重度颈动脉狭窄或伴有血栓形成的复杂斑块），而对照组仅为7%（p < 0.0001）。
以活化部分凝血活酶时间监测的治疗性肝素化形式进行即刻抗凝，是治疗急性脑缺血和视网膜缺血的合理且低风险方案。
