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首页> 外文期刊>Herz >Management of oral anticoagulation related intracerebral hemorrhage
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Management of oral anticoagulation related intracerebral hemorrhage

机译：口腔抗凝治疗相关脑出血

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The incidence of intracerebral hemorrhage(ICH) in patients using oral anticoagulation(OAC) will continue to increase with the demographic change of an aging population. As compared to primary spontaneous ICH, OAC-ICH is characterized by larger hematoma volumes, more frequent hematoma enlargement and intraventricular hemorrhage resulting in an even worse prognosis. Specific treatment should focus on immediate reversal of anticoagulation in addition to the basic acute management of ICH. In ICH patients using vitamin K antagonists(VKA), complete anticoagulant reversal with an international normalized ratio(INR) <1.3 should be achieved as quickly as possible using prothrombin complex concentrate(PCC) with additional substitution of vitamin K. Patients with ICH under dabigatran treatment should receive idarucizumab. In ICH patients using factor-Xa inhibitors, andexanet should be administered as soon as approved in Europe or within clinical studies and if unavailable alternatively high-dose PCC administration. Regarding OAC resumption, results from randomized trials are pending. In comprehensive observational studies and meta-analyses ICH patients resuming OAC showed a reduced incidence of thromboembolic events and mortality without significantly increased rates of hemorrhagic complications. Non-vitamin K dependent oral anticoagulants(NOAC) might further increase the safety of OAC resumption, which should be initiated after 4-8weeks for patients with atrial fibrillation. In contrast, VKA resumption in patients with mechanical heart valves should not take place earlier than 1 week after ICH. Generally, safety of OAC resumption appears to be affected by ICH localization along with the presence of cerebral microbleeding, cortical superficial siderosis and cortical/convexity subarachnoid hemorrhage, making it crucial to weigh up the individual patient risk with respect to thromboembolic versus hemorrhagic events.
机译：使用口服抗凝患者（OAC）患者脑出血（ICH）的发病率随着老龄化人口的人口变化将继续增加。与原发性自发性ICH相比，OAC-ICH的特征在于较大的血肿体积，更频繁的血肿扩大和静脉内出血导致甚至更差的预后。除了ICH的基本急性管理外，具体治疗应专注于抗凝立即逆转。在使用维生素K拮抗剂（VKA）的ICH患者中，应尽可能快地通过用凝血酶体复合浓缩物（PCC）尽可能快地实现具有国际归一化比率（INR）<1.3的完全抗凝逆转，并使用果实浓缩菌（PCC）与维生素K.患者在Dabigatran下的Ich治疗应该接受idarucizumab。在使用因子-Xa抑制剂的ICH患者中，应该在欧洲批准或临床研究中立即管理ANDEXNET，如果不可用的或不可用的高剂量PCC给药。关于OAC恢复，随机试验的结果待定。在综合观察研究和荟萃分析中，恢复OAC的患者表现出血栓栓塞事件和死亡率的发病率降低，而没有显着增加出血并发症的速率。非维生素K所依赖口服抗凝血剂（NOAC）可能进一步提高OAC恢复的安全性，这应该在4-8周后为心房颤动的患者发起。相比之下，机械心阀患者的VKA恢复不应在ICH后1周早期发生。通常，OAC恢复的安全性似乎受到ICH定位的影响以及脑微微细胞，皮质浅表性肺炎和皮质/凸状蛛网膜瘤出血的存在，这使得对血栓栓塞与出血事件的称重称重个体患者风险至关重要。

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