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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Medical Treatment for Spontaneous Anticoagulation-Related Intracerebral Hemorrhage in the Netherlands
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Medical Treatment for Spontaneous Anticoagulation-Related Intracerebral Hemorrhage in the Netherlands

机译：荷兰自发性抗凝相关性脑出血的医疗

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Background: Spontaneous anticoagulation-related intracerebral hemorrhage accounts for up to a quarter of spontaneous intracerebral hemorrhage cases and is associated with higher hematoma volume and a worse outcome. Guidelines recommend rapid anticoagulant reversal but mode and timing are not specified and optimal strategy is uncertain. Variability in everyday practice is unknown. Methods: An invitation to a web-based survey was sent to 85 Dutch stroke neurologists in different hospitals, with questions about importance, timing, and medical management of spontaneous anticoagulation-related intracerebral hemorrhage. Results: In total, 61 (72%) neurologists completed the survey. Nearly all (97%) deemed rapid anticoagulant reversal important. A local guideline for management of anticoagulant reversal was used in 80% of the hospitals. Most neurologists (56%) estimated anticoagulant reversal in anticoagulation-related intracerebral hemorrhage to start later than intravenous thrombolysis in ischemic stroke. Few (5%) thought it was quicker. A minority (28%) of the hospitals started anticoagulation reversal without waiting for laboratory test results or consulting a specialist in hemostasis. Prothrombin complex concentrate was used by all neurologists for vitamin K antagonist reversal and by most (74%) for reversal of thrombin inhibitors and factor Xa inhibitors (72%). Anticoagulation reversal was initiated at the emergency department according to 89% of the respondents. Conclusion: Variability in logistics in acute management of spontaneous anticoagulation-related intracerebral hemorrhage was demonstrated. Anticoagulant reversal is deemed important, but is estimated to have a longer door-to-needle time than alteplase in thrombolysis for ischemic stroke by most neurologists. Several delaying factors were found. These factors might have an impact on outcome. (C) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
机译：背景：自发性抗凝相关脑出血占自发性脑出血病例的四分之一，且与更高的血肿体积和更差的预后相关。指南建议快速抗凝逆转，但没有规定模式和时机，最佳策略也不确定。日常实践中的可变性是未知的。方法：向不同医院的85名荷兰中风神经科医生发出网络调查邀请，询问自发性抗凝相关脑出血的重要性、时机和医疗管理。结果：共有61名（72%）神经科医生完成了调查。几乎所有人（97%）都认为快速抗凝逆转很重要。80%的医院使用了当地的抗凝剂逆转管理指南。大多数神经科医生（56%）估计，缺血性卒中患者抗凝相关脑出血的抗凝逆转开始时间晚于静脉溶栓。很少有人（5%）认为这样更快。少数医院（28%）在没有等待实验室检测结果或咨询止血专家的情况下开始抗凝逆转。凝血酶原复合物浓缩物被所有神经学家用于维生素K拮抗剂逆转，大多数（74%）用于凝血酶抑制剂和因子Xa抑制剂逆转（72%）。89%的受访者表示，抗凝逆转是在急诊科启动的。结论：在自发性抗凝相关脑出血的急性处理中，后勤保障存在差异。抗凝剂逆转被认为是重要的，但据大多数神经学家估计，在缺血性中风的溶栓治疗中，抗凝剂逆转比阿替普酶具有更长的门到针时间。发现了几个延迟因素。这些因素可能会对结果产生影响。（C） 2017年全国中风协会。爱思唯尔公司出版。版权所有。

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