关于脑出血后患者重启口服抗凝药的思考  

Resuming of oral anticoagulation after intracerebral hemorrhage

作　　者：白雪[1] 胡志[1] BAI Xue;HU Zhi(Department of Critical Care Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院重症医学科,成都610041

出　　处：《华西医学》2021年第11期1613-1617,共5页West China Medical Journal

基　　金：国家重点研发计划(2018YFA0108604)。

摘　　要：脑出血后重启口服抗凝药(oral anticoagulant,OAC)是具有挑战性的话题。目前尚无高质量的随机对照试验能获知何时以何种方式重启OAC是安全的。最近几年一些重要研究认为,脑出血后重启OAC可降低栓塞事件的发生率和长期死亡率,且不明显增加出血风险;重启OAC在非脑叶出血患者比脑叶出血患者更安全;新型抗凝剂优于维生素K拮抗剂;建议高栓塞风险患者在脑出血后2周或更早重启OAC,非栓塞高风险患者在4~8周重启OAC,同时需考虑个体情况,严控血压。Resuming oral anticoagulant(OAC)after intracerebral hemorrhage(ICH)is still a dilemma to clinical decision.To date,no high-quality randomized controlled trials demonstrate the timing and mode of safely resuming OAC.In recent years,some moderate-quality researches have suggested that OAC resuming after ICH can decrease the incidence of thromboembolic events and long-term mortality,without significantly increasing the risk of ICH;it is safer to resuming OAC in patients with non-lobar ICH than in patients with lobar-ICH;new OACs are superior to vitamin K antagonists;patients with high thromboembolic risk should resume OAC 2 weeks or even earlier after ICH,otherwise,a time-window for optimal resumption is between 4-8 weeks;meanwhile,individual patient characteristics should be considered and blood pressure should be strictly controlled.

关 键 词：脑出血 口服抗凝药物 治疗 

分 类 号：R743.34[医药卫生—神经病学与精神病学]