Anticoagulant-Related Hemorrhage in Acute Cerebral Embolism
Anticoagulant-Related Hemorrhage in Acute Cerebral Embolism
复制标题
急性脑栓塞抗凝相关出血
作者：
R. Shields;R. Laureno;T. Lachman;M. Víctor
据报道，有 5 名心源性非脓毒性脑栓塞患者，早期抗凝治疗导致临床恶化或因急性梗塞出血而死亡。每名患者的初次 CT 扫描均排除了脑内出血的存在，而在临床恶化后进行的第二次 CT 扫描则记录了梗死区明显的出血情况。所有五名患者均在右侧大脑中动脉区域出现大面积梗塞，其中三名患者患有轻度高血压。 4 名患者在中风后 36 小时内接受了肝素治疗，1 名患者在栓塞发生时正在服用华法林。间隔数小时（2例）、5-6天（2例）和30天（1例）后出现临床恶化。只有 2 名患者在临床恶化时抗凝活性过高。本报告说明了急性非脓毒性脑栓塞早期抗凝治疗的危险，特别是在大面积梗塞的情况下。 《中风》第 15 卷，第 3 期，1984 年
Five patients with nonseptic cerebral embolism of cardiac origin are reported in whom early anticoagulant therapy resulted in clinical deterioration or death from frank hemorrhage into the acute infarct. In each patient an initial CT scan excluded the presence of intracerebral hemorrhage and a second CT scan, after clinical deterioration had occurred, documented frank hemorrhage into the infarcted zone. All five patients had large infarctions in the right middle cerebral artery territory and three patients were mildly hypertensive. Four patients received heparin within 36 hours of their stroke and one was on warfarin at time of the embolism. Clinical deterioration occurred after intervals of several hours (2 cases), 5-6 days (2 cases) and 30 days (1 case). In only 2 patients was anticoagulant activity excessive at time of clinical deterioration. This report illustrates the danger of early anticoagulant therapy of acute nonseptic cerebral embolism, particularly in the setting of large infarction. Stroke Vol 15, No 3, 1984