口服抗凝剂相关脑出血逆转方案的研究进展  

Recent advances in anticoagulation reversal of oral anticoagulant-associated intracerebral hemorrhage

作　　者：周钰森 尹江柳 胡丽君 龚勇 Zhou Yusen;Yin Jiangliu;Hu Lijun;Gong Yong(Department of Neurosurgery,Changsha Central Hospital,University of South China,Changsha 410004,China)

机构地区：[1]南华大学附属长沙中心医院神经外科,长沙410004

出　　处：《中国医师杂志》2023年第9期1435-1440,共6页Journal of Chinese Physician

基　　金：湖南省科技创新计划项目(2018JJ6086)。

摘　　要：随着人口的老龄化和心血管疾病患病率的增加,口服抗凝剂(OAC)的人数逐年增多。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7~10倍。并且相比于一般的ICH患者,口服抗凝剂相关脑出血(OAC-ICH)患者的出血量更大、病死率较高以及血肿扩大(HE)率更高。因此,无论患者使用的是维生素K拮抗剂(VKA)还是新型口服抗凝剂(NOAC),运用迅速与特定的方案逆转抗凝血状态,对降低HE率从而潜在地改善ICH的临床结局至关重要。本文综述不同OAC逆转方案的历史和研究进展,为OAC-ICH患者选择更加合理的逆转方案提供理论依据。With the progressive aging of the population and the attendant increase in oral anticoagulants(OAC)use,studies have shown that the risk of intracerebral hemorrhage(ICH)in patients receiving OAC treatment is 7-10 times higher than that in patients not receiving OAC treatment.Moreover,compared to general ICH patients,patients with oral anticoagulant-associated intracerebral hemorrhage(OAC-ICH)exhibit larger ICH-volumes,have higher mortality,and importantly have a greater frequency of hematoma expansion(HE).Hence,aggressive and specific medical management to reverse anticoagulation irrespective of vitamin K antagonists(VKA)or new oral anticoagulants(NOAC)used is essential to reduce HE rates and thereby to potentially influence clinical outcomes.This paper aims to compare and analyze the history and latest progress of reversal scheme in different OAC,so as to provide a theoretical basis for patients with OAC-ICH to pick a more reasonable reversal scheme.

关 键 词：抗凝药 口服 脑出血 抗凝逆转 

分 类 号：R743.34[医药卫生—神经病学与精神病学]