抗血小板藥物相關腦出血的處置

Management of Antiplatelets-Associated Intracerebral Hemorrhage

林欣儀(Shin-Yi Lin) ； 湯頌君(Sung-Chun Tang) ； 鄭建興(Jiann-Shing Jeng)

《台灣中風醫誌》 2卷1期 (2020/03) Pp. 35-42

https://doi.org/10.6318/FJS.202003_2(1).0003

摘要

抗血小板藥物如aspirin、clopidgorel、cilostazol是最常使用的抗血栓藥物之一，雖然與腦出血的發生率、出血擴大或死亡的關聯性尚不明確，但在重大出血時，了解可能的逆轉處置，乃是臨床上重要的課題。學理上，輸注血小板在藥物濃度偏高時未必能有效拮抗藥物療效，且輸注過程可能導致不良反應，目前的證據僅在需進行外科手術的病人看到好處。Desmopressin可迅速改善血小板功能，但維持效果短。相對的，其副作用如潮紅與心悸，也大多短暫且輕微。Tranexamic acid可能降低急性腦出血的早期出血擴大與死亡率。與對照組相比，並不增加副作用發生的機會與栓塞風險，但對長期預後的改善沒有影響。出血穩定後，應評估病人再次使用抗血小板劑的適應症。目前對於最適當的加藥時機仍沒有定論，臨床上還是須依據個案評估。

關鍵字

Antiplatelets ； Desmopressin ； Intracerebral hemorrhage ； Tranexamic acid

並列摘要

Antipletlet agents such as aspirin, clopidogrel, cilosatzol are commonly prescribed antithrombotic agents. Whether antiplatelet therapy would increase the risk of intracranial hemorrhage, hematoma expansion and mortality remains controversial. Nevertheless, understanding the potential strategies to reverse the pharmacological effect of antiplatelet drugs is essential for physicians in clinical practice. Theoretically, platelet transfusion does not necessary reverse the drug effect of antiplatelet agents, especially when the drug level is high. Besides, transfusion carries potential side effects. Based on current evidence, the benefit of platelet transfusion was only observed among patients who received surgical intervention. Desmopressin can rapidly improve platelet function, but the effect is short. Common side effects such as palpitation and facial flushing are usually mild and transient. One recent clinical trial suggested that tranexamic acid may prevent early hematoma expansion and reduce early mortality in patients with acute intracerebral hemorrhage. Also the use of tranexamic acid did not increase thrombosis and side effects comparing to placebo. But the use of tranexamic acid did not improve long-term functional outcomes. Once the bleeding is stabilized, the indication and timing to restart antiplatelet therapy should be carefully reevaluated and the clinical decision should be made individually for each patient.

並列關鍵字

Antiplatelets ； Desmopressin ； Intracerebral hemorrhage ； Tranexamic acid