抗凝剂防治缺血性脑卒中的临床证据

Clinical Evidence of Anticoagulants in Ischaemic Stroke Prevention and Treatment

通过检索Cochrane图书馆（2005年第3期）、MEDLINE（1996～2005年）。总结和评价抗凝剂防治缺血性脑卒中的高质量临床研究证据，以了解抗凝剂治疗缺血性脑卒中的效果与安全性及其在缺血性脑卒中一级和二级预防中的作用。结果显示，缺血性脑卒中急性期不推荐常规立即给予抗凝治疗；急性期的抗凝治疗不能有效降低患者的死亡或残疾，反而增加出血事件的发生；对有心源性栓塞风险的高危人群，抗凝治疗能相对安全有效地降低卒中及其他血管事件的发生。而对非心源性栓塞人群，抗凝治疗在利与弊之间难以取得平衡。

To evaluate the effectiveness and safety of anticoagulants in ischaemic stroke primary or secondary prevention and treatment, we searched The Cochrane Library and MEDLINE to find high quality evidence and summarized the available evidence. The results showed that routine immediate anticoagulant therapy in patients with acute ischaemic stroke should not be recommended because it increased the risk of hemorrhage with ineffective reduction to the risk of death or disability. For the high risk group with cardiogenic embolism, anticoagulant therapy could safely and effectively reduce the incidence of stroke or other vascular events. However, for non-cardiogenic embolism group, anticoagulant therapy was hard to balance the benefits and harms.