治疗前、治疗中和治疗后：急性缺血性中风患者直接口服抗凝剂溶栓治疗的安全性和更佳疗效论证

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY Annals of Neurology Pub Date : 2024-09-11 DOI:10.1002/ana.27058

Sanaz Monjazeb MD, Heather V. Chang BS, Patrick D. Lyden MD

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引用次数: 0

摘要

直接口服抗凝剂是心房颤动患者预防中风的主要选择。然而，中风前使用抗凝剂可能会影响临床医生在中风发生时对溶栓治疗的适应性。缺血性卒中后恢复使用抗凝药物也会因担心出血而产生问题。我们描述了大量文献，其中显示中风后使用直接抗凝剂溶栓是安全的。尽早恢复直接抗凝剂治疗与较低的栓塞复发风险和较低的出血风险有关。在溶栓前、溶栓期间和溶栓后使用直接抗凝剂似乎是安全的，并有可能改善缺血性中风后的预后。ann neurol 2024

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Before, during, and after: An Argument for Safety and Improved Outcome of Thrombolysis in Acute Ischemic Stroke with Direct Oral Anticoagulant Treatment

Direct oral anticoagulants are the primary stroke prevention option in patients with atrial fibrillation. Anticoagulant use before stroke, however, might inhibit clinician comfort with thrombolysis if a stroke does occur. Resuming anticoagulants after ischemic stroke is also problematic for fear of hemorrhage. We describe extensive literature showing that thrombolysis is safe after stroke with direct anticoagulant use. Early reinstitution of direct anticoagulant treatment is associated with lower risk of embolic recurrence and lower hemorrhage risk. The use of direct anticoagulants before, during, and after thrombolysis appears to be safe and is likely to promote improved outcomes after ischemic stroke. ANN NEUROL 2024;96:871–886

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.