低分子肝素治疗急性缺血性中风疗效和安全性

Effect and safety of low-molecular-weight heparin in the treatment of acute ischemic stroke

目的:评价低分子肝素(LMWH)治疗急性缺血性中风的疗效和安全性.方法:入选病例均用低分子右旋糖苷作基础治疗,治疗组加用LMWH.治疗组:3例进展型短暂脑缺血发作(TIA)及31例发病48h内脑梗死,LMWH4100anti-XaIU,bid,腹壁sc,连续10d.对照组:31例脑梗死.采用中风评分法在用药后1mo进行总评价.用发光底物法测定LMWH浓度.结果:3例TIA症状很快缓解.治疗组的总有效率(90.3%)明显优于对照组(64.5%),P<0.05.同时,起病24h内开始LMWH治疗的显效率(84.2%)优于起病24～48h才开始LMWH治疗的显效率(41.7%),P<0.02.高峰和低谷血药浓度分别为(0.32±0.17)及(0.26±0.19)anti-XaIU.未发现出血倾向.结论:低分子肝素治疗急性缺血性中风是安全有效的.

AIM: To study the effect and safety of low-molecular-weight heparin (LMWH) in the treatment of acute ischemic stroke. METHODS: All patients treated with dextran as base treatment. 3 patients with cerebral transient ischemic attack(TIA) and 31 patients with cerebral infarction within 48h of stroke onset were treated with “add-on”LMWH. There were 31 randomized patients as control. Fraxiparine (4 100 anti-factor Xa IU ,bid)was given subcutaneously for 10 days. Functional outcome at 1 mo after the stroke was assessed according to China Stroks Scale. The plasma LMWH concentration was monitored with col-orimetric assay. RESULTS:The symptoms of all 3 patients with TIA were controlled quickly. The total improving rate of cerebral infarction treated with LMWH(90. 3%)was significantly greater than that of control (64. 5%) ,P<0. 05. Meantimes,the remarkable improving rate in patients treated with LMWH within 24 hours of onset (82. 7%) was significantly greater than that between 24 and 48 hours (52. 9%),P<0. 02. The plasma concentration of LMWH in peak and valley was (0. 32 ± 0. 17), (0. 26 ± 0. 19)anti-Xa IU, respectively. No hemorrhage tendency was found. CONCLUSION: LMWH in the treatment of acute ischemic stroke is effective and safe.