缺血性脑卒中抗凝治疗进展

美国指南有关抗凝药物治疗的新推荐
At present, the usefulness of argatroban or other thrombin inhibitors for treatment of patients with acute ischemic stroke is not well established. These agents should be used in the setting of clinical trials.
Dabigatran, a direct thrombin inhibitor, has been evaluated over the past decade for the prevention of orthopedic procedures.
did not increase mortality or the risk of serious bleeding.
IIb / B
NEW
The usefulness of urgent anticoagulation in patients with severe stenos is of an internal carotid artery ipsilateral to an ischemic stroke is not well established
缺血性脑卒中抗凝治疗进展
——直接凝血酶 抑制剂的崛起
LOGO
血栓形成机制示意图
2

缺血性卒中抗栓的特异性治疗 抗凝
溶栓
抗血小板
3

急性脑梗死抗凝治疗的作用机制
预防早期卒中复发 (再血栓栓塞)
阻止神经症状的恶化 (防止血栓延长)
发
展
1935年普通肝素 iv（ ATⅢ+Ⅹa +Ⅱa）
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抗凝药物的分类
进入美国新版指南
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2013年美国AHA/（ASA）最新急性缺 血性卒中早期管理指南
2007年
2013年
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Stroke. published online Jawnwuwar.tyh3em1,e2g0a1lle3r;
首次将直接凝血酶抑制剂（阿加曲班、达比加群）写入美国指 南，以区分传统的间接凝血酶抑制剂（肝素、低分子肝素）。 单独对直接凝血酶抑制剂进行了介绍，并有新的推荐意见。
9
Stroke. published online Janwuwawry.t3h1em , 2e0g1a3lle;
美国指南对达比加群的背景介绍
改善卒中预后 (改善微循环和血供)
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抗凝药物的作用靶点及发展历史
2008年 p.oⅡa和Ⅹa 因子抑制剂
多
靶
2002年 磺达肝素 iv（ATⅢ+Ⅹa）
点
向
1990年阿加曲班 iv （Ⅱa）
单
一
1980年低分子肝素 ih（ ATⅢ+Ⅹa +Ⅱa）
靶
点
1940年华法令 p.o( Ⅱ,Ⅶ,Ⅸ,Ⅹ ,C,S)
In October 2010, the FDA approved the higher 150-mg twice-a-day dose for stroke prevention in patients with atrial fibrilla-tion. For patients with impaired renal function, a lower 75-mg twice-a-day dose is recommended.
More recently, in the RE-LY study (Randomized Evaluation of Longterm Anticoagulation Therapy), dabigatran demonstrated benefit compared with warfarin for the prevention of stroke or systemic embolization in patients with atrial fibrillation. At lower doses, dabigatran was noninferior to warfarin while demonstrating fewer hemorrhagic complications. At higher doses, dabigatran was more effective than warfarin but had similar bleeding risk.
10
Stroke. published onlinewJawnwu.athreym3e1g,a2l0le1ry3.;com
美国指南对阿加曲班的背景介绍
A dose-escalation study of argatroban, also a direct
thrombin inhibitor, found that it prolonged aPTT levels but
IIb / B
NEW
8
Stroke. published online Janwuwawry.t3h1em , 2e0g1a3lle;
美国指南对直接凝血酶抑制剂的背景评论
Direct thrombin inhibitors may be useful in acute ischemic stroke because of their actions that limit thrombosis. These medications could be considered as an alternative to anticoagulants, and they could be administered to those people who develop heparinassociated thrombocytopenia.