急性缺血性卒中血管内治疗围手术期抗凝治疗研究进展

doi:10.3969/j.issn.1673-5765.2024.02.015

摘要/Abstract

摘要： 目前急性缺血性卒中（acute ischemic stroke，AIS）患者在血管内治疗（endovascular treatment，EVT）围手术期进行抗凝治疗的安全性和有效性尚未明确。现有研究表明，在EVT术前使用抗凝药物并不会增加患者出血或不良预后的风险。而EVT术中抗凝虽然无法显著提高血管再通率，但对于改善患者的长期预后可能有积极作用。此外，EVT术后抗凝可以预防颅内动脉再闭塞的发生，并可能有改善脑部微循环的作用。因此，对于抗凝指征更加明确的、伴有心房颤动的AIS患者是否可以尽早开始抗凝值得进一步探索，今后仍需开展更多临床研究来评估AIS患者EVT围手术期抗凝治疗的安全性和有效性。

文章导读： 现有的临床研究结果表明，EVT围手术期抗凝治疗并不会明显增加颅内出血风险，且对于减少血管再闭塞和改善患者长期预后可能有积极作用。期待临床提供更多的循证证据，明确最佳抗凝药物及其治疗剂量，从而持续优化EVT围手术期抗凝治疗策略。

关键词: 卒中; 血管内治疗; 围手术期; 抗凝

Abstract: The safety and efficacy of anticoagulation therapy in the perioperative period of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) are still not well defined. Current studies suggest that the use of anticoagulant drug before EVT does not increase the risk of hemorrhage or poor prognosis in AIS patients. Although anticoagulation therapy during EVT does not significantly increase the efficiency of vascular recanalization, it may have a positive effect on improving the long-term prognosis of patients. In addition, anticoagulation therapy after EVT can prevent the occurrence of intracranial arterial reocclusion while potentially improving cerebral microcirculation. Therefore, the possibility of early initiation of anticoagulation therapy in AIS patients with atrial fibrillation who have a clearer indication for anticoagulation warrants further study. More clinical studies should be conducted to further evaluate the safety and efficacy of anticoagulation therapy during perioperative period of EVT in AIS patients.

Key words: Stroke; Endovascular treatment; Perioperative period; Anticoagulation

中图分类号:

许亚宁, 张猛. 急性缺血性卒中血管内治疗围手术期抗凝治疗研究进展[J]. 中国卒中杂志, 2024, 19(2): 219-226.

XU Yaning, ZHANG Meng. Research Progress of Anticoagulation Therapy during Perioperative Period for Endovascular Treatment of Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2024, 19(2): 219-226.

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