心源性脑梗死合并脑微出血患者口服抗凝剂的安全性分析

目的 探讨心源性脑梗死(CE)合并脑微出血(CMBs)患者口服抗凝剂应用的安全性.方法 将243例CE患者分为CMBs组105例和无CMBs组138例,根椐NHISS评分不同及1-3-6-12法则启动抗凝治疗,所选抗凝药物包括华法林、利伐沙班及达比加群酯,所有患者1年随访,终点事件为症状性出血(ICH),头颅CT以证实.结果 CE不同抗凝剂治疗之间的出血转化率比较差异无统计学意义;华法林治疗后CE合并CMBs组较无CMBs组出血转化率差异有统计学意义;启动抗凝后CE合并CMBs组(NHISS≥8分)较无CMB组(≥8分)出血转化发生率差异有统计学意义.结论 在CE患者不同抗凝治疗均可以选择,但针对CE合并CMBs患者,新型口服抗凝药(NOACs)可能更合适,对于中重度CE患者合并CMBs,抗凝治疗需谨慎.

Objective To explore the safety of anticoagulant in patients with cardiogenic infarction(CE)and cerebral micro hemorrhage(CMBS).Methods 243 patients with cardiogenic infarction were divided into CMBS group(105 cases)and non CMBS group(138 cases).Anticoagulant therapy was initiated according to the different NHISS scores and the 1-3-6-12 rule.Anticoagulants selected included warfarin,rivaroxaban and dabigatran ester.All patients were followed up for one year.Symptomatic hemorrhage(ICH)was the end event,which was confirmed by skull CT.Results There was no significant difference in the conversion rate of bleeding between CE and different anticoagulants.There was significant difference in the conversion rate of bleeding between CE group and CMBS group after warfarin treatment compared with CMBS group.There was significant difference in the conversion rate of bleeding between CE group and CMBS group after anticoagiilation.Conclusion Different anticoagulant therapy can be selected in patients with CE,blit NOACS may be more suitable for patients with CE and CMBS,and anticoagulant therapy should be cautious for patients with moderate or severe CE and CMBS.