抗凝血劑相關性腦出血的藥物治療

Medication Treatment in Anticoagulant-Associated Intracerebral Hemorrhage

陳思汝(Szu-Ju Chen) ； 林欣儀(Shin-Yi Lin) ； 蔡力凱(Li-Kai Tsai)

《台灣中風醫誌》 1卷3期 (2019/12) Pp. 185-193

https://doi.org/10.6318/FJS.201912_1(3).0002

並列摘要

Anticoagulant-associated intracerebral hemorrhage (ICH) is one of the major causes of spontaneous ICH. Studies reported that anticoagulant-associated ICH (AICH) accounted for up to 14% of spontaneous ICH in western population and 2.6% in Taiwan. AICH had the worst prognosis among all causes of spontaneous ICH. The mortality was estimated at 60% and less than 20% of patients could walk independently at 3-months post ICH. Reversing anticoagulant effect was considered the cornerstone of treating AICH. Reducing activity of anticoagulant may lead to a smaller hematoma volume and better prognosis. Sine various anticoagulants work through different mechanisms, the reversal method differs. Vitamin K antagonist was the most common oral anticoagulant that works by inhibiting vitamin K-associated coagulation factors. Prescribing Vitamin K and prothrombin complex concentrate (PCC) is the first-line treatment of vitamin K antagonist-associated ICH. Non-vitamin K antagonist oral anticoagulants could be classified into direct thrombin inhibitor and factor Xa inhibitor. Idarucizumab is the reversal agent of the direct thrombin inhibitor, dabigatran, and should be prescribed immediately in dabigatran-related ICH. As for factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, the reversal agent, andexanet alpha, has been developed and approved by FDA but not widely available yet. Before a reversal agent could be achieved, PCC should be considered in factor Xa inhibitor-associated ICH. Protamine is the reversal agent of heparin, and should be given in heparin-associated ICH though the efficacy differs in different types of heparin.

並列關鍵字

Anticoagulants ； Intracerebral hemorrhage ； Reversal agents ； Stroke