缺血性卒中的抗凝治疗

几个大规模、多中心、随机试验发现,天然肝素(UFH)或低分子肝素(LMWH)并不能改善急性缺血性卒中患者的总体预后。紧急抗凝可预防长期卧床急性缺血性卒中患者深静脉血栓的形成。伴房颤及附加危险因素,如附壁血栓和(或)新发心肌梗死的心源性栓塞性卒中患者具有较高复发性卒中危险,若无显著出血可紧急抗凝。华法令抗凝可作为伴心房纤颤卒中患者的初级和二级预防。颅内静脉窦栓塞形成、颈动脉夹层和抗磷脂抗体综合征患者可常规抗凝,而非心源性栓塞性卒中或症状性颅内动脉狭窄综合征患者长期抗凝治疗证据不足。

Anticoagulation treatment for ischemic stroke patients

Unfractionated heparin(UFH) or low molecular weight heparin(LMWH) can not improve the prognosis of the patients with acute ischemic stroke according to some large, multicenter, randomized trials. Urgent anticoagulation after acute ischemic stroke can prevent deep vein thrombosis among bed-ridden patients .In view of a high risk of recurrent stroke in the patients with cardioembolic stroke,especially those with atrial fibrillation and additional risk factors such as mural thrombus and/or recent myocardial infarction, urgent administration of anticoagulants is appropriate for the patients without bleeding risk. For the primary and secondary prevention of stroke in the patients with atrial fibrillation, warfarin should be strongly considered for patients with high risks for stroke. Use of anticoagulants is reasonable in the patients with cerebral venous thrombosis, cervical artery dissection, and antiphospholipid antibody syndrome,but there is no evidence to support the use of long-term anticoagulation in the patients with non-cardioembolic ischemic stroke or symptomatic intracranial stenosis.