患有心房的人的二次中风预防:治疗方法和试验
David J Seiffge1, Virginia Cancelloni2, Lorenz Räber3
1Department of Neurology, Inselspital University Hospital Bern and University of Bern, Switzerland.
The Lancet. Neurology
|March 20, 2024
概括
心房动增加了中风的风险. 早期的抗凝药和新疗法可以预防复发性中风,但尽管有抗凝药,中风后的二次预防仍然是一个挑战.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 心房动是一种常见的心律失常,也是缺血性中风的主要原因.
- 了解心房的负担和相对于中风的时间对于复发风险至关重要.
- 二次预防旨在减轻心房动患者的复发性缺血性中风.
研究的目的:
- 对心房动和中风患者的当前二次预防策略进行审查.
- 为了突出直接口服抗凝剂治疗开始中风后的最佳时间.
- 讨论新兴疗法和二次中风预防的未满足需求.
主要方法:
- 对抗凝血剂治疗时间的随机对照试验的综述.
- 分析新兴的治疗方法,如节律控制和左心房尾闭塞.
- 检查中风患者的二次预防尽管抗凝药和那些有先前的脑内出血.
主要成果:
- 早期启动直接口服抗凝剂 (48小时内轻度/中度,大脑中风4-5天) 似乎是安全的,并减少早期复发.
- 包括节律控制,左心房尾闭塞和XI因子抑制剂在内的新疗法显示出进一步降低风险的前景.
- 尽管服用抗凝血药物,但在患有心房的患者中发生中风的二次预防是未满足的需求,目前仍在进行研究.
结论:
- 开始抗凝血的最佳时间是心房动中二次中风预防的关键.
- 新兴疗法为减少这一群体中风风险提供了新的途径.
- 需要进一步的研究来解决二次预防的挑战,特别是在先前有脑内出血的患者或尽管服用抗凝血药物,但却中风的患者中.
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