缺血性脑血管病的抗栓治疗研究进展

ADVANCES OF ANTITHROMBOTIC AGENTS IN CEREBRAL ISCHEMIA

本文对防治缺血性脑血管病的抗栓药物研究进展进行了综述，主要有抗血小板药。抗凝药、溶栓药。阿司匹林是最常用于防治缺血性脑血管病的药物，噻氯匹啶虽然效果好，但由于不良反应多且严重，从而限制了其临床应用，仅作为对阿司匹林不能耐受的二线药，而抗血小板药仅能降低２５－３０％的危险性；抗凝药对防治因心源性栓塞所致的缺血性脑血管病有效，但是否可用于防治非心源性栓塞所致的缺血性脑血管病尚不清楚，且需进行血液学监护；尽早应用溶栓药有益于促进脑血管的再灌，治疗缺血性脑血管病，在发作后６ｈ内使用溶栓药的效果较好且较安全，然而最近一些多中心临床试验发现溶栓治疗虽可改善临床症状和减少致残，但有增加患者脑溢血及死亡的危险。因此，如何保证溶栓治疗的安全性值得深入探讨。一些新型抗栓药物如直接凝血酶抑制药。特异性抗血小板药及新型抗凝药等正在开发研究之中，临床前研究结果表明这些药物在防治缺血性脑血管疾病中具有一定的应用前景，但仅限于临床前试验，其防治缺血性脑血管病的有效性和安全性尚需深入研究。

The advances of antithrombotic agents in cerebral ischemia were reviewed. There are three kinds of drugs available named antiplatelet agents, anticoagulants and thrombolytics, for treatment of cerebral ischemia. Antiplatelet agents are considered the most beneficial in thrombotic stroke, they can reduce the risk of cerebral ischemia relapse by 25-30%. Of which, aspirin is typically the choice of antiplatelet agent for cerebral ischemia prevention. Ticlopidine is more effective than aspirin in thrombotic stroke prevention, but its severe adverse drug reactions restrict its use.Anticoagulants are highly effective for prevention of cerebral ischemia caused by cardiac embolism,but their effectiveness in non-cardioembolic stroke is uncertain, and blood monitoring should be warranted during their uses. Thrombolytic therapy as early as possible after ischemic stroke onset is beneficial to reperfusion and prevention of neuronal damage. In addition, when given within 6 hours of ischemia onset, thrombolytics appear to be relatively safe and effective.However, recent multicentre acute stroke trials found excess of early deaths and intracerebral haetniorrhages, although improvement of clinical symptom come over long term. The benefit of thrombolys is in therapy should be evalu-ated extensively. Several newly developed antithrombotic agents, such as direct antithrombins, specific antiplatelet agents and new anticoagulation inhibitors, are being evaluated.