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首页> 外文学位 >Restarting Oral Anticoagulant in Patients with Mechanical Heart Valve(s) and Intracranial Haemorrhage.
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Restarting Oral Anticoagulant in Patients with Mechanical Heart Valve(s) and Intracranial Haemorrhage.

机译：患有机械性心脏瓣膜和颅内出血的患者应重新开始口服抗凝药。

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摘要

Patients with mechanical heart valves who present with intracranial haemorrhage are initially treated by reversing their coagulopathy. However, these patients will ultimately require that their oral anticoagulant be restarted. The time at which oral anticoagulants are restarted is critical since restarting too early may increase the risk of recurrent bleeding, while withholding anticoagulants increases the patient's risk of thromboembolic events. The ideal time to restart patients on their oral anticoagulant medication is defined as the time at which all these risks are minimized.;This thesis includes a systematic review and meta-analysis of the literature. The main outcomes were recurrent haematoma, valve thrombosis, stroke and peripheral emboli. Results were stratified by types of intracranial haemorrhage. We also conducted a survey to gain insight into current practices of neurosurgeons and thrombosis experts in Canada and USA when they are faced with deciding on anticoagulant restart times in patients with ICH. Results were stratified by type of intracranial bleed and participants' characteristics and demographics.;The systematic review identified that the ideal time for restarting anticoagulant therapy in patients following an ICH is unknown. Meta-analysis was limited by the heterogeneity of the studies.;The survey results indicated that physicians had a wide range of practice and that their practice was dependent on the patient's clinical features, but many physicians would restart oral anticoagulants between 4 and 14 days after the haemorrhage. For this reason we have proposed a multi centre cohort study to investigate the safety and efficacy of restarting patients on anticoagulation therapy between day 5 and 9 post haemorrhage. A full study protocol is presented in this thesis.
机译：患有颅内出血的机械性心脏瓣膜病患者首先要通过逆转凝血病进行治疗。但是，这些患者最终将需要重新开始口服抗凝剂。口服抗凝剂重新开始的时间至关重要，因为过早重新开始可能会增加再次出血的风险，而保留抗凝剂会增加患者发生血栓栓塞事件的风险。重新开始使用口服抗凝药物的患者的理想时间定义为将所有这些风险降至最低的时间。;本文包括对文献进行系统的回顾和荟萃分析。主要结局是复发性血肿，瓣膜血栓形成，中风和周围血栓。结果按颅内出血的类型分层。我们还进行了一项调查，以深入了解加拿大和美国的神经外科医师和血栓形成专家在决定ICH患者抗凝重启时间时的当前做法。结果根据颅内出血的类型，参与者的特征和人口统计学进行分层。系统评价确定，ICH后患者重新开始抗凝治疗的理想时间尚不清楚。荟萃分析受到研究异质性的限制。调查结果表明，医生的执业范围广泛，其执业取决于患者的临床特征，但许多医生会在术后4至14天重新开始口服抗凝药出血。因此，我们提出了一项多中心队列研究，以研究出血后第5天至第9天重新开始抗凝治疗的患者的安全性和有效性。本文提出了完整的研究方案。

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  • 作者

    Alkherayf, Fahad.;

  • 作者单位

    University of Ottawa (Canada).;

  • 授予单位 University of Ottawa (Canada).;
  • 学科 Health Sciences Medicine and Surgery.
  • 学位 M.Sc.
  • 年度 2012
  • 页码 263 p.
  • 总页数 263
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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