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颅内出血患者抗栓药逆转指南美国神经重症监护学会和美国重症医学会对医疗卫生专业人员的声明

国际脑血管病杂志 2016年第11期24卷 961-985页

作者： jennifer A. Frontera John J. Lewin Ⅲ Alejandro A. Rabinstein Imo P. Aisiku Anne W. Alexandrov Aaron M. Cook Gregory J. del Zoppo Monisha A. Kumar ellinor I. B. Peerschke Michael F. Stiefel Jeanne S Teitelbaum Katja e. Wartenberg Cindy L. Zerfoss 杨一萍谢丽丽宁小金季宇腾柯开富 From the Cerebrovascular Center Neurological Institute Cleveland Clinic and Case Western Reserve University 9500 Euclid Ave. S80 Cleveland OH44195 USA The Departments of Pharmacy and Anesthesiology & Critical Care Medicine The Johns Hopkins Hospital and Johns Hopkins University School of Medicine Baltimore MD USA The Department of Neurology Mayo Clinic Rochester MN USA Harvard Medical School Brigham and Women's Hospital Boston MA USA The University of Tennessee Health Science Center Memphis TN USA Department of Pharmacy Practice & Science (UK College of Pharmacy) University of Kentucky Lexington KY USA The Departments of Medicine (Hematology) and Neurology University of Washington School of Medicine Seattle WA USA The Departments of Neurology Neurosurgery Anesthesiology & Critical Care Perelman School of Medicine Hospital of the University of Pennsylvania Philadelphia PA USA The Department of Laboratory Medicine and Pathology Memorial Sloan Kettering Cancer Center and Weill Comell Medical School New York NY USA The Department of Neurosurgery Westchester Medical Center New York Medical College Valhalla NY USA Hepital du Sacre-Coeur and University of Montreal and Montreal Neurological Institute and McGill University Montreal Quebec Canada Klinik fur Neurologie Martin-Luther-Universitat Halle-Wittenberg Halle Germany The Neuroscience and Neurosurgery Departments Centra Lynchburg General Hospital Lvnchburg VA. USA 南通大学附属医院神经内科 226001

背景抗栓药的使用，包括抗凝药、抗血小板药和溶栓药，在过去10年中日益增多并且预计将继续上升。虽然抗栓药相关性颅内出血可能是灾难性的，但快速逆转凝血功能障碍可能有助于限制血肿增大和改善转归。方法美国神经重症监护学会联合美... 详细信息

背景抗栓药的使用，包括抗凝药、抗血小板药和溶栓药，在过去10年中日益增多并且预计将继续上升。虽然抗栓药相关性颅内出血可能是灾难性的，但快速逆转凝血功能障碍可能有助于限制血肿增大和改善转归。方法美国神经重症监护学会联合美国重症医学会组建了一个国际性多机构委员会，涉及的专业领域包括神经重症监护、神经内科、神经外科、卒中、血液学、血液病理学、急诊医学、药学、护理和指南制定，目的是进行文献评价并制定一份循证实践指南。该委员会进行了正式的文献检索，并对符合标准的研究进行了评价。结果利用GRADe方法学，委员会提出了在颅内出血情况下逆转维生素K拮抗药、直接Xa因子拮抗药、直接凝血酶抑制药、普通肝素、低分子肝素、类肝素、戊多糖、溶栓药和抗血小板药的推荐意见。结论该指南提供了及时和循证的抗栓药逆转策略以协助临床医生治疗抗栓药相关性颅内出血。