阿加曲班与脑梗死PPT.pptVIP

参与研究中心名单 病例选择 1.132例缺血性脑卒中患者，平均年龄62.04。 2.入选标准： LOGO 缺血性脑卒中抗凝治疗进展 ——直接凝血酶抑制剂的崛起 血栓形成机制示意图 缺血性卒中抗栓的特异性治疗 抗 凝 溶 栓 抗血小板 急性脑梗死抗凝治疗的作用机制 预防早期卒中复发 (再血栓栓塞) 阻止神经症状的恶化 (防止血栓延长) 改善卒中预后 (改善微循环和血供) 2013年美国AHA/（ASA）最新急性缺血性卒中早期管理指南 2007年 2013年 Stroke. published online January 31, 2013; 美国指南有关抗凝药物治疗的新推荐 At present, the usefulness of argatroban or other thrombin inhibitors for treatment of patients with acute ischemic stroke is not well established. These agents should be used in the setting of clinical trials. The usefulness of urgent anticoagulation in patients with severe stenos is of an internal carotid artery ipsilateral to an ischemic stroke is not well established NEW NEW Stroke. published online January 31, 2013; 美国指南对直接凝血酶抑制剂的背景评论 Direct thrombin inhibitors may be useful in acute ischemic stroke because of their actions that limit thrombosis. These medications could be considered as an alternative to anticoagulants, and they could be administered to those people who develop heparin-associated thrombocytopenia. Stroke. published online January 31, 2013; 首次将直接凝血酶抑制剂（阿加曲班、达比加群）写入美国指南，以区分传统的间接凝血酶抑制剂（肝素、低分子肝素）。单独对直接凝血酶抑制剂进行了介绍，并有新的推荐意见。 美国指南对达比加群的背景介绍 Dabigatran, a direct thrombin inhibitor, has been evaluated over the past decade for the prevention of thromboembolic events in patients after orthopedic procedures. More recently, in the RE-LY study (Randomized Evaluation of Long-term Anticoagulation Therapy), dabigatran demonstrated benefit compared with warfarin for the prevention of stroke or systemic embolization in patients with atrial fibrillation. At lower doses, dabigatran was noninferior to warfarin while demonstrating fewer hemorrhagic complications. At higher doses, dabigatran was more effective than warfarin but had similar bleeding risk. In October 2010, the FDA approved the higher 150-mg twice-a-day dose for stroke prevention in patients with atrial fibrilla-tion. For patients with impaired renal function, a lowe