Symptomatic intracerebral hemorrhage in acute ischemic stroke after thrombolysis with intravenous recombinant tissue plasminogen activator: a review of natural history and treatment.
Symptomatic intracerebral hemorrhage in acute ischemic stroke after thrombolysis with intravenous recombinant tissue plasminogen activator: a review of natural history and treatment.
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DOI：
10.1001/jamaneurol.2014.1210
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发表时间：
2014-09
期刊：
影响因子：
29
通讯作者：
Willey JZ
中科院分区：
文献类型：
--
作者：
Yaghi S;Eisenberger A;Willey JZ
静脉溶栓仍然是急性缺血性卒中的主要治疗方法。最令人担心的治疗并发症之一是溶栓相关的症状性脑出血（sICH），发生在近6%的患者中，死亡率接近50%。sICH的治疗选择基于小病例系列和专家意见，推荐治疗的疗效尚不清楚。概述sICH潜在治疗的基本原理和作用机制，这些治疗可能在血肿扩大前逆转凝血功能障碍。在PubMed检索中确定了基于证据的同行评审文章，包括随机试验、病例系列和报告以及回顾性综述，内容涉及静脉内重组组织型纤溶酶原激活剂的作用机制以及使用凝血级联反应作为模型的各种潜在治疗的原理。检索包括1990年1月1日至2014年2月28日发表的文章。目前的治疗可能不足以足够早地逆转凝血病以防止血肿扩大并改善溶栓相关出血的结局。鉴于静脉注射重组组织型纤溶酶原激活剂的作用机制，临床研究可能包括起效快的药物，如凝血酶原复合物浓缩物、重组因子VIIa和ε-氨基己酸，作为潜在的治疗选择。
Intravenous thrombolysis remains the mainstay treatment for acute ischemic stroke. One of the most feared complications of the treatment is thrombolysis-related symptomatic intracerebral hemorrhage (sICH), which occurs in nearly 6% of patients and carries close to 50% mortality. The treatment options for sICH are based on small case series and expert opinion, and the efficacy of recommended treatments is not well known. To provide an overview on the rationale and mechanism of action of potential treatments for sICH that may reverse the coagulopathy before hematoma expansion occurs. Evidence-based peer-reviewed articles, including randomized trials, case series and reports, and retrospective reviews, were identified in a PubMed search on the mechanism of action of intravenous recombinant tissue plasminogen activator and the rationale of various potential treatments using the coagulation cascade as a model. The search encompassed articles published from January 1, 1990, through February 28, 2014. The current treatments may not be sufficient to reverse coagulopathy early enough to prevent hematoma expansion and improve the outcome of thrombolysis-related hemorrhage. Given the mechanism of action of intravenous recombinant tissue plasminogen activator, clinical studies could include agents with a fast onset of action, such as prothrombin complex concentrate, recombinant factor VIIa, and ε-aminocaproic acid, as potential therapeutic options.