与口服抗凝剂治疗相关的脑内出血患者在神经重症护理治疗时的血肿增大和预后:应用维生素K、新鲜冷冻血浆和凝血酶原复合物急性治疗策略的比较

作     者：Huttner H.B. Schellinger P.D. Hartmann M. 郭俊 

作者机构：Dr.Department of Neurology and NeuroradiologyUniversity of HeidelbergINF 40069120 HeidelbergGermany 

出 版 物：《世界核心医学期刊文摘(神经病学分册)》 (Digest of the World Core Medical Journals.Clinical Neurology)

年 卷 期：2006年第12期

页      面：36-37页

学科分类：1011[医学-护理学（可授医学、理学学位）] 10[医学] 

主　　题：血肿增大 患者 抗凝剂 凝血酶原复合物 脑内出血 血浆 维生素 预后 

摘      要：BACKGROUND AND PURPOSE-Intracerebral hemorrhage(ICH)is the most serious and potentially fatal complication of oral anticoagulant therapy(OAT).Still,there are no universally accepted treatment regimens for patients with OAT-ICH,and randomized controlled trials do not *** aim of the present study was to compare the acute treatment strategies of OAT-associated ICH using vitamin K(VAK),fresh frozen plasma(FFP),and prothrombin complex concentrates(PCCs)with regard to hematoma growth and *** In this retrospective study,a total of 55 treated patients were *** groups were compared by reviewing the clinical,laboratory,and neuroradiological parameters:(1)patients who received PCCs alone or in combination with FFPor VAK(n=31),(2)patients treated with FFP alone or in combination with VAK(n=18),and(3)patients who received VAK as a monotherapy(n=6).The end points of early hematoma growth and outcome after 12 months were analyzed including multivariate ***-Hematoma growth within 24 hours occurred in 27%of *** and extent of hematoma growth were significantly lower in patients receiving PCCs(19%/44%)compared with FFP(33%/54%)and VAK(50%/59%).However,this effect was no longer seen between PCC-and FFP-treated patients if international normalized ratio(INR)was completely reversed within 2 hours after *** overall outcome was poor(modified Rankin scale 4 to 6 in 77%).Predictors for hematoma growth were an increased INR after 2 hours,whereas administration of PCCs was significantly protective in multivariate *** for a poor outcome were age,baseline hematoma volume,and occurrence of hematoma ***-Overall,PCC was associated with a reduced incidence and extent of hematoma growth compared with FFP and *** effect seems to be related to a more rapid INR *** controlled trials are needed to identify the most effective acute treatment regimen for lasting INR reversal because increa