Antithrombotic dilemmas in stroke medicine: new data, unsolved challenges

被引：12

作者：

Best, Jonathan G. ^{[1
]}

Cardus, Beatrix ^{[2
]}

Klijn, Catharina J. M. ^{[3
]}

Lip, Gregory ^{[4
,5
]}

Seiffge, David J. ^{[6
]}

Smith, Eric E. ^{[7
]}

Werring, David J. ^{[1
]}

机构：

[1] UCL Queen Sq Inst Neurol, Stroke Res Ctr, London, England

[2] Royal Surrey Cty Hosp, Royal Surrey NHS Fdn Trust, Guildford, Surrey, England

[3] Radboud Univ Nijmegen, Med Ctr, Donders Inst Brain Cognit & Behav, Dept Neurol, Nijmegen, Netherlands

[4] Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England

[5] Aalborg Univ, Aalborg Thrombosis Res Unit, Aalborg, Denmark

[6] Univ Hosp, Inselspital, Dept Neurol, Bern, Switzerland

[7] Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci Radiol & Community Hlth Sci, Calgary Stroke Program, Calgary, AB, Canada

来源：

JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY | 2022年 / 93卷 / 09期

关键词：

cerebrovascular disease; stroke; clinical neurology; ACUTE ISCHEMIC-STROKE; DIRECT ORAL ANTICOAGULANTS; NONVALVULAR ATRIAL-FIBRILLATION; CORTICAL SUPERFICIAL SIDEROSIS; HEALTH-CARE PROFESSIONALS; INTRACEREBRAL HEMORRHAGE; INTRACRANIAL HEMORRHAGE; CARDIOEMBOLIC STROKE; CEREBRAL MICROBLEEDS; PRACTICE RECOMMENDATIONS;

D O I：

10.1136/jnnp-2020-325249

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Antithrombotic therapy is a key element of secondary prevention in patients who have had an ischaemic stroke or transient ischaemic attack. However, its use in clinical practice is not always straightforward. This review provides an update on certain difficult scenarios in antithrombotic management, with a focus on recent clinical trials and large observational studies. We discuss the approach to patients with an indication for antithrombotic treatment who also have clinical or radiological evidence of previous intracranial bleeding, patients with indications for both anticoagulant and antiplatelet treatment, and patients in whom antithrombotic treatment fails to prevent stroke. We also review the timing of anticoagulation initiation after cardioembolic stroke, and the use of antithrombotics in patients with asymptomatic cerebrovascular disease. Despite a wealth of new evidence, numerous uncertainties remain and we highlight ongoing trials addressing these.

引用

页码：939 / 951

页数：13

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