在无症状 (无声) 大脑微出血和疑似大脑粉样性血管病变的心血管管理
Andreas Charidimou1, Eric E Smith2
1Department of Neurology, Boston University Medical Center and Boston University School of Medicine, MA (A.C.).
Stroke
|March 11, 2024
概括
磁力共振成像扫描中的大脑微型血流 (CMB) 经常引起人们对抗血栓药物安全性的担忧. 然而,新出现的证据表明,单独使用CMB通常不应该阻止它们在指示时用于预防中风.
科学领域:
- 神经学 神经学
- 放射学 放射学是一门学科.
- 血管医学 血管医学
背景情况:
- 大脑微出血 (CMB) 是MRI常见的发现,通常表明小血管疾病.
- 它们在中风和认知障碍中的流行引起了人们对抗血栓药物安全性的担忧.
- 历史上对出血风险的强调可能导致血栓状况的治疗不足.
研究的目的:
- 在各种临床环境中审查沉默的CMB和表面 siderosis 的影响.
- 讨论在CMB患者中使用抗血栓剂和抗凝剂的安全性.
- 提供关于在CMBs存在时管理抗血栓治疗的临床指导.
主要方法:
- 文献审查和对现有证据的批判性讨论.
- 在一般人群中分析CMB,缺血性中风患者和记忆诊所的参与者.
- 综合临床实践观察和现有研究.
主要成果:
- 沉默的CMB和表面 siderosis是普遍存在的,并与临床不确定性相关.
- 新出现的证据表明,单独使用CMB并不违反抗血栓/抗凝剂治疗的适用情况.
- 由于缺乏明确的指导方针,临床实践存在很大差异.
结论:
- 总的来说,CMBs不应该排除用于预防中风的抗血栓剂或抗凝剂的使用.
- 需要进一步的研究,包括随机对照试验,以巩固指南.
- 临床决策应根据个体患者的因素平衡出血和血栓风险.
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