Anticoagulation in cerebral ischemia.
Anticoagulation in cerebral ischemia.
复制标题
脑缺血时的抗凝。
作者：
Weksler,BB;Lewin,M
抗凝治疗明显有利于有脑血栓风险的中风患者。相反，完全性缺血性卒中患者并没有受益，而且可能会因为出血并发症而表现出更高的死亡率和发病率。在脑出血的早期准确诊断、持续肝素输注和更密切的抗凝监测方面的技术进步继续降低了接受治疗的患者的出血风险。在TIA患者中，使用抗血小板药物的替代疗法正在研究中，这种疗法似乎可以在较低的出血风险下预防中风。目前的结果表明，这两种疗法之间没有差异，但只有历史对照可用于评估益处。抗凝是否能阻止进展期卒中患者神经功能障碍的进展仍然是一个未解的问题，只能通过前瞻性、随机、对照试验来解决。
Anticoagulation clearly benefits patients at risk of stroke from cerebral embolism. Conversely, patients with completed ischemic stroke are not benefited, and may show a higher mortality and morbidity because of hemorrhagic complications. Technical advances in the early, accurate diagnosis of cerebral hemorrhage, the constant infusion of heparin, and closer monitoring of anticoagulation have continued to reduce the risk of hemorrhage in treated patients. In patients with TIA, alternative therapy with anti-platelet agents, which appears to prevent stroke at less bleeding risk, is under study. Current results show no differences between the two therapies, but only historical controls are available for evaluation of benefit. Whether or not anticoagulation prevents progression of neurologic deficit in patients with strokes-in-evolution remains an unanswered question, which can be resolved only by prospective, randomized, controlled trials.