Antithrombotic treatments in acute ischemic stroke
Antithrombotic treatments in acute ischemic stroke
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DOI：
10.1097/00062752-200009000-00009
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发表时间：
2000-09-01
影响因子：
3.2
通讯作者：
del Zoppo, GJ
中科院分区：
文献类型：
--
作者：
del Zoppo, GJ
缺血性中风最常见的原因是脑动脉血栓形成。抗血栓药物可以减少脑栓塞事件的发生率或组织损伤的程度和神经系统结果。抗血小板药物阿司匹林、噻氯匹定以及双嘧达莫和阿司匹林的组合与第二次局灶性脑缺血事件的显着减少相关。口服抗凝剂具有降低机械心脏瓣膜或非瓣膜性房颤患者心源性栓塞发生率的作用。这两种抗血栓药物均未经在急性环境下进行测试。重组组织纤溶酶原激活剂 rt-PA 已被证明，在症状出现 3 小时内接受治疗，可显着增加无缺陷或极少缺陷的中风患者数量。通过静脉内和动脉内递送对该方法和其他纤溶酶原激活剂进行的其他研究强调了这种方法的局限性，但也支持其在急性干预中的作用。脑出血的风险与所有抗血栓药物的使用有关，尤其是纤溶酶原激活剂。降低这种风险的策略可能会增加有益的结果。 (C) 2000 Lippincott Williams & Wilkins, Inc.
Ischemic stroke results most commonly from cerebral arterial thrombosis. Antithrombotic agents can reduce the incidence of cerebral embolic events or the extent of tissue injury and neurological outcome, The antiplatelet agents aspirin, ticlopidine, and the combination of dipyridamole and aspirin are associated with a significant reduction in second focal cerebral ischemic events. Oral anticoagulants have a role to reduce the incidence of cardiogenic emboli in patients with mechanical cardiac valves or nonvalvular atrial fibrillation. Both antithrombotics are untested in the acute setting. The recombinant tissue plasminogen activator rt-PA has been shown to significantly increase the number of stroke patients with no or minimal deficit when treated within 3 hours of symptom onset. Additional studies of this and other plasminogen activators by both intradvenous and intra-arterial delivery have highlighted limitations to this approach, but also support its role in acute intervention. The risk cf intracerebral hemorrhage attends the use of all antithrombotic agents, most notably plasminogen activators. Strategies to decrease this risk are likely to add to beneficial outcome. (C) 2000 Lippincott Williams & Wilkins, Inc.