口服抗凝剂相关脑出血的再认识

在人口老龄化进程不断加剧的背景下,口服抗凝剂(OAC)越来越多地用于临床实践,尤其是随着新型口服抗凝剂(NOAC)的适应证不断扩大,以NOAC为代表的抗凝时代已经到来.口服抗凝剂相关脑出血(OAC-ICH)是一种发生在抗凝治疗下的医源性效应,研究显示接受OAC治疗的患者脑出血(ICH)发生风险较未接受OAC治疗的患者高...

Re-recognition of Oral Anticoagulant-associated Intracerebral Hemorrhage

In the context of the aging population,oral anticoagulants(OACs)are increasingly used in clinical practice,especially with the continuous expansion of the indications of novel oral anticoagulants(NOACs),the anticoagulation era represented by NOACs has come.Oral anticoagulant-associated intracerebral hemorrhage(OAC-ICH)is an iatrogenic effect that occurs with anticoagulant therapy.Studies have shown that the risk of cerebral hemorrhage in patients receiving OAC treatment is 7-10 times higher than that in patients not receiving OAC treatment,and cerebral hemorrhage is a serious adverse event of anticoagulation therapy,which has attracted the attention of clinicians.Based on the relevant research in recent years,the author analyzes the occurrence risk,prognosis,potential etiology,secondary brain injury,clinical manifestations and imaging features,bleeding location and prognosis predictors of OAC-ICH as follows:although the incidence of OAC-ICH is not high,its occurrence means that patients have a poor prognosis and need to bear a higher economic burden;OAC-ICH patients have high mortality and poor functional prognosis;incorporating imaging markers(eg,cerebral microbleeds)into clinical bleeding risk assessment may improve the prediction efficiency of ICH;brain injury secondary to ICH is mainly physical destruction of brain parenchyma structure,and NOACs-related ICH has a lower risk of hematoma expansion and death compared with warfarin;the clinical manifestations of OAC-ICH are similar to other causes of cerebral hemorrhage,and the"fluid level"phenomenon on CT imaging is expected to be used as an imaging marker for OAC-ICH;there are differences in the location of bleeding between OAC-ICH and non-OAC-ICH;the predictors related to the poor prognosis of OAC-ICH mainly include the level of consciousness on admission and the amount of cerebral hemorrhage,hematoma expansion,hematoma location,intraventricular hemorrhage,medical intervention and comorbidities.