A I Baranich, A A Sychev, I A Savin, V G Kudrina, A V Kozlov
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引用次数: 0
Abstract
Background: Hemorrhagic stroke is associated with high risk of adverse outcome and follows intake of anticoagulants and antiplatelet agents in 25% of cases. The latest clinical guidelines of the Neurocritical Care Society for correction (reversal) of the effect of anticoagulants and antiplatelet agents in hemorrhagic stroke were published in 2016.
Material and methods: In accordance with PRISMA recommendations, we reviewed the PubMed, eLibrary and UpToDate databases to a depth of 5 years and selected 48 articles.
Results and discussion: Direct oral anticoagulants are currently common. To reverse their effect, one can use specific antidotes (idarucizumab is recommended for dabigatran, andexanet alfa (not yet registered In Russia) for factor Xa inhibitors (rivaroxaban, apixaban)) and combination of prothrombin complex concentrate and tranexamic acid. Protamine sulfate is antidote for unfractionated and low molecular weight heparins. Protamine sulfate completely inactivates unfractionated heparin, but it is less effective against low molecular weight heparin. It is characterized by high probability of anaphylactic reactions, especially after repeated administrations. The effectiveness of andexanet alpha and activated factor VII for reversing the effect of low molecular weight heparin is being studied. Fondaparinux sodium is used for heparin-induced thrombocytopenia. Protamine sulfate is ineffective for reversing the effect of fondaparinux. One can use prothrombin complex concentrate and andexanet alpha, but their effectiveness is unclear. Ciraparantag is being studied in clinical trials. Apparently, ciraparantag is highly effective as an antidote for various anticoagulants.
Conclusion: Early hemostatic therapy and reversal of anticoagulant effects in patients with hemorrhagic stroke significantly reduce the risk of adverse outcomes. This problem is being studied. Regular literature review with creation of updated clinical guidelines is needed.
背景：出血性卒中与不良后果的高风险相关，25%的病例服用了抗凝血和抗血小板药物。2016年，美国神经危重症护理学会（Neurocritical Care Society）发布了最新的关于出血性卒中中抗凝、抗血小板药物纠正（逆转）作用的临床指南。材料和方法：根据PRISMA的建议，我们对PubMed、library和UpToDate数据库进行了5年的深度检索，并选择了48篇文章。结果与讨论：目前直接口服抗凝血剂较为常见。为了逆转它们的作用，可以使用特定的解毒剂（达比加群推荐使用idarucizumab，而Xa因子抑制剂（利伐沙班，阿哌沙班）推荐使用dexanet alfa（尚未在俄罗斯注册））和凝血酶原复合物浓缩物和氨甲环酸的组合。硫酸鱼精蛋白是未分离和低分子量肝素的解毒剂。硫酸鱼精蛋白完全灭活未分离肝素，但对低分子量肝素效果较差。它的特点是高概率的过敏反应，特别是在反复给药后。目前正在研究anddexanet α和活化因子VII对逆转低分子量肝素作用的有效性。Fondaparinux钠用于肝素诱导的血小板减少症。硫酸鱼精蛋白对逆转氟达哌啶钠的作用无效。人们可以使用凝血酶原复合物浓缩物和和德沙奈，但它们的效果尚不清楚。Ciraparantag正在临床试验中进行研究。显然，ciraparantag作为各种抗凝血剂的解毒剂非常有效。结论：出血性卒中患者早期止血治疗和抗凝作用逆转可显著降低不良结局的发生风险。这个问题正在研究中。需要定期的文献回顾和更新临床指南的创建。
期刊介绍：
Scientific and practical peer-reviewed journal. This publication covers the theoretical, practical and organizational problems of modern neurosurgery, the latest advances in the treatment of various diseases of the central and peripheral nervous system. Founded in 1937. English version of the journal translates from Russian version since #1/2013.
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