1、特殊情况的抗栓治疗 缺血性脑卒中脑出血转化 颅内出血 房颤合并冠心病 围手术期管理 缺血性脑血管疾病患者抗栓治疗 缺血性脑卒中脑出血转化 HI 出血性梗死： HI1 小点状出血 HI2 多个融合的点状出血 PH 脑实质出血 PH1 30% 梗死灶有轻微占位效应出血 PH2 30%梗死灶有明显占位效应出血或远离梗死灶出血 缺血性脑卒中出血转化的抗栓治疗 2010 中国卒中急性期指南 缺血性脑卒中出血转化的抗栓治疗 3. 对于出血性脑梗死患者，根据患者的临床情况（无症状和出血量少）及抗凝适应症时，可以考虑继续抗凝。 Class IIb; Level of Evidence C Guidelines
2、 for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Stroke. published online May 1, 2014 特殊情况的抗栓治疗 缺血性脑卒中脑出血转化 颅内出血 房颤合并冠心病 围手术期管理 缺血性脑血管疾病患者抗栓治疗 1. 脑出血后重新开始抗栓治疗的决策制定，依赖于 随后的动脉或静脉血栓栓塞的风险大小、脑出血再发的风险、病人的全身情况 ，所以对每个病人必须制定个体化的方案。 *脑梗死风险 相对较低 病人（如房颤但没有缺血性脑卒中史）和脑出血再发 风险较高 （如高龄的脑叶出
3、血或可疑淀粉样脑血管病患者）或者整个神经系统功能很差，可以考虑应用 抗血小板药物 来预防缺血性脑卒中。 颅内出血后的抗凝治疗 Class IIb; Level of Evidence B Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Stroke. published online May 1, 2014 2.对于急性脑出血、蛛网膜下腔出血或硬脑膜下出血后，何时恢复或开始抗凝治疗，最佳时机尚无定论。大多数病人来说，发病至少 1周以上较为合理 颅内出血后的抗凝治疗 :
4、Class IIb; Level of Evidence B Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Stroke. published online May 1, 2014 特殊情况的抗栓治疗 缺血性脑卒中脑出血转化 颅内出血 房颤合并冠心病 围手术期管理 缺血性脑血管疾病患者抗栓治疗 For patients with AF and stable coronary artery disease (eg, no acute coronary syndrome
5、within the previous year) who choose oral anticoagulation suggest adjusted-dose VKA therapy alone (target INR range, 2.0-3.0) rather than the combination of adjusted-dose VKA therapy and aspirin (Grade 2C) Antithrombotic Therapy for Atrial Fibrillation Antithrombotic Therapy and Prevention of Thromb
6、osis, 9th ed： American College of Chest Physicians Evidence-Based Clinical Practice Guidelines For patients with AF at intermediate to high risk of stroke (eg, CHADS2 score 1) who experience an acute coronary syndrome and do not undergo intracoronary stent placement suggest for the first 12 months a
7、djusted-dose VKA therapy (INR 2.0-3.0) plus single antiplatelet therapy rather than dual antiplatelet therapy (eg, aspirin and clopidogrel) or triple therapy (eg, warfarin, aspirin, and clopidogrel) (Grade 2C). Antithrombotic Therapy for Atrial Fibrillation Antithrombotic Therapy and Prevention of Thrombosis, 9th ed： American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
