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1、Click to edit Master text styles,Second level,Third level,Fourth level,Click to edit Master title style,#,缺血性腦卒中腦出血轉(zhuǎn)化,HI,出血性梗死：,HI1,小點(diǎn)狀出血,HI2,多個(gè)融合的點(diǎn)狀出血,PH,腦實(shí)質(zhì)出血,PH1 30%,梗死灶有輕微占位效應(yīng)出血,PH2,30%,梗死灶有明顯占位效應(yīng)出血或遠(yuǎn)離梗死灶出血,缺血性腦卒中出血轉(zhuǎn)化的抗栓治療,2010,中國(guó)卒中急性期指南,缺血性腦卒中出血轉(zhuǎn)化的抗栓治療,3.,對(duì)于出血性腦梗死患者，根據(jù)患者的臨床情況（無(wú)癥狀和出血量少）及抗凝適應(yīng)癥時(shí)，可
2、以考慮繼續(xù)抗凝。,Class,IIb,;Level of Evidence C,Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic,Stroke.,published online May 1,2014,特殊情況的抗栓治療,缺血性腦卒中腦出血轉(zhuǎn)化,顱內(nèi)出血,房顫合并冠心病,圍手術(shù)期管理,缺血性腦血管疾病患者抗栓治療,腦出血后重新開始抗栓治療的決策制定，依賴于,隨后的動(dòng)脈或靜脈血栓栓塞的風(fēng)險(xiǎn)大小、腦出血再發(fā)的風(fēng)險(xiǎn)、病人的全身情況,，所以對(duì)每個(gè)病人必須制定個(gè)體化的方案。,*腦梗
3、死風(fēng)險(xiǎn),相對(duì)較低,病人（如房顫但沒有缺血性腦卒中史）和腦出血再發(fā),風(fēng)險(xiǎn)較高,（如高齡的腦葉出血或可疑淀粉樣腦血管病患者）或者整個(gè)神經(jīng)系統(tǒng)功能很差，可以考慮應(yīng)用,抗血小板藥物,來(lái)預(yù)防缺血性腦卒中。,顱內(nèi)出血后的抗凝治療,Class,IIb,;Level of Evidence B,Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic,Stroke.,published online May 1,2014,2.,對(duì)于急性腦出血、蛛網(wǎng)膜下腔出血或硬腦膜下出血后，何時(shí)恢復(fù)或開始抗凝治
4、療，最佳時(shí)機(jī)尚無(wú)定論。大多數(shù)病人來(lái)說(shuō)，發(fā)病至少,1,周以上較為合理,顱內(nèi)出血后的抗凝治療,:,Class,IIb,;Level of Evidence B,Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic,Stroke.,published online May 1,2014,特殊情況的抗栓治療,缺血性腦卒中腦出血轉(zhuǎn)化,顱內(nèi)出血,房顫合并冠心病,圍手術(shù)期管理,缺血性腦血管疾病患者抗栓治療,For patients with AF and,stable coronary a
5、rtery disease,(eg,no acute coronary syndrome within the previous year),who choose oral anticoagulation,suggest adjusted-dose VKA therapy alone(target INR range,2.0-3.0)rather than the combination of adjusted-dose VKA therapy and aspirin (Grade 2C),Antithrombotic Therapy for Atrial Fibrillation,Antit
6、hrombotic Therapy and Prevention of Thrombosis,9th ed,：,American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,For patients with AF at,intermediate to high risk of stroke,(eg,CHADS,2,score 1)who experience an,acute coronary syndrome,and,do not undergo intracoronary stent pl
7、acement,suggest for the first 12 months,adjusted-dose VKA therapy(INR 2.0-3.0)plus single antiplatelet therapy,rather than dual antiplatelet therapy(eg,aspirin and clopidogrel)or triple therapy(eg,warfarin,aspirin,and clopidogrel),(Grade 2C).,Antithrombotic Therapy for Atrial Fibrillation,Antithromb
8、otic Therapy and Prevention of Thrombosis,9th ed,：,American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,For patients with AF at,intermediate to high risk of stroke,After the first 12 months,antithrombotic therapy is suggested as for patients with AF and stable coronary ar
9、tery disease,Antithrombotic Therapy for Atrial Fibrillation,Antithrombotic Therapy and Prevention of Thrombosis,9th ed,：,American College of Chest Physicians Evidence-Based Clinical,Practice Guidelines,For patients with AF at,high risk of stroke,(eg,CHADS,2,score,2),during,the,first month after plac
10、ement of a bare-metal stent,or,the first 3 to 6 months after placement of a drug-eluting stent,suggest triple therapy,(eg,VKA therapy,aspirin,and lopid-ogrel)rather than dual antiplatelet therapy(eg,aspirin and clopidogrel)(Grade 2C),Antithrombotic Therapy for Atrial Fibrillation,Antithrombotic Ther
11、apy and Prevention of Thrombosis,9th ed,：,American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,For patients with AF at,high risk of stroke,After this initial period of triple therapy,suggest a VKA(INR 2.0-3.0)plus a single antiplatelet drug,rather than VKA alone (Grade 2C
12、).,12 months after intracoronary stent placement,antithrombotic therapy is suggested as for patients with AF and stable coronary artery disease,Antithrombotic Therapy for,Atrial Fibrillation,Antithrombotic Therapy and Prevention of Thrombosis,9th ed,：,American College of Chest Physicians Evidence-Ba
13、sed Clinical Practice Guidelines,patients with nonvalvular AF,CHA2DS2-VASc score is recommended for assessment of stroke risk,(Level of Evidence:B),high risk of stroke,with prior stroke,transient ischemic attack(TIA),or a CHA2DS2-VASc score of 2 or greater,2014 AHA/ACC/HRS Guideline for the Manageme
14、nt of Patients With Atrial Fibrillation,For patients with nonvalvular AF,oral anticoagulants are recommended Options include:,warfarin(INR 2.0 to 3.0),(Level of Evidence:A),dabigatran,(Level of Evidence:B),rivaroxaban,(Level of Evidence:B),apixaban,(Level of Evidence:B),2014 AHA/ACC/HRS Guideline fo
15、r the Management of Patients With Atrial Fibrillation,如暫停口服抗凝藥，需要過(guò)渡性治療嗎？,warfarin(INR 2.,Class IIb;Level of Evidence B,(Level of Evidence:A),Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Stroke.,2個(gè)一級(jí)證據(jù)、1個(gè)二級(jí)證據(jù)、1個(gè)三級(jí)證據(jù)的臨床研究，肝素過(guò)渡性治療可增加出血風(fēng)險(xiǎn),暫?？鼓幬锼卵ㄋㄈL(fēng)險(xiǎn),停藥所致的血栓栓
16、塞風(fēng)險(xiǎn),沒有足夠證據(jù)支持眼科手術(shù)時(shí)需停用華法林(Level U).,(Grade 2C).,肌電圖、前列腺手術(shù)、腹股溝疝修補(bǔ)術(shù)、大隱靜脈消融手術(shù),Summary of evidence-based guideline:Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease,Neurology 80 May 28,2013,Summary of evidence-based guideline:Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease,Neurology 80 May 28,2013,雖然出血性不良事件罕見,PH2 30%梗死灶有明顯占位效應(yīng)出血或遠(yuǎn)離梗死灶出血,patients with AF undergoing percutaneous coronary int
特殊情況的抗栓治療臺(tái)州ppt課件
