A*******s
发帖数: 9638 | 1 Hospitalists like to give heparin drip for acute stroke patients with atrial
fibrillation. This is a controversial topic. Anticoagulation is indicated
for cardiac emboli and atrial fibrillation, but when stroke size is large,
anticoagulation would put patients on the risk of hemorrhagic transformation
. What should we do?
Here is a review article:
http://stroke.ahajournals.org/content/38/2/423.long
So we should not routinely anticoagulate acute stroke patients with a-fib.
However, if patients are having crescendo TIAs, or found to have a cardiac
thrombosis, etc, you may have to adjust your strategies.
Still confused? read the article, lol | S**********e
发帖数: 1325 | 2 Abstract
Background and Purpose— The role of anticoagulant treatment for acute
cardioembolic stroke is uncertain. We performed an updated meta-analysis of
all randomized trials to obtain the best estimates of the efficacy and
safety of anticoagulants for the initial treatment of acute cardioembolic
stroke.
Methods— Using electronic and manual searches of the literature, we
identified randomized trials comparing anticoagulants (unfractionated
heparin or low-molecular-weight heparin or heparinoids), started within 48
hours, with other treatments (aspirin or placebo) in patients with acute
ischemic cardioembolic stroke. Two reviewers independently selected studies
and extracted data on study design, quality, and clinical outcomes,
including death or disability, all strokes, recurrent ischemic stroke, and
cerebral symptomatic bleeding. Odds ratios for individual outcomes were
calculated for each trial and data from all the trials were pooled using the
Mantel-Haenszel method.
Results— Seven trials, involving 4624 patients with acute cardioembolic
stroke, met the criteria for inclusion. Compared with other treatments,
anticoagulants were associated with a nonsignificant reduction in recurrent
ischemic stroke within 7 to 14 days (3.0% versus 4.9%, odds ratio 0.68, 95%
CI: 0.44 to 1.06, P=0.09, number needed to treat=53), a significant increase
in symptomatic intracranial bleeding (2.5% versus 0.7%, odds ratio 2.89; 95
% CI: 1.19 to 7.01, P=0.02, number needed to harm=55), and a similar rate of
death or disability at final follow up (73.5% versus 73.8%, odds ratio 1.01
; 95% CI: 0.82 to 1.24, P=0.9).
Conclusions— Our findings indicate that in patients with acute
cardioembolic stroke, early anticoagulation is associated with a
nonsignificant reduction in recurrence of ischemic stroke, no substantial
reduction in death and disability, and an increased intracranial bleeding. | h*******l
发帖数: 1542 | 3 好文章。
这篇文章的结果不支持在急性缺血性中风的患者早期使用抗凝血剂。
早期阿司匹林维生素K拮抗剂长期二级预防是更合理的选择。
总的来说，他们还是支持传统的保守治疗方法。但是如果遇到严重急性缺血性中风的患
者，可以使用肝素等抗凝血剂。
atrial
indicated
transformation
【在 A*******s 的大作中提到】
: Hospitalists like to give heparin drip for acute stroke patients with atrial
: fibrillation. This is a controversial topic. Anticoagulation is indicated
: for cardiac emboli and atrial fibrillation, but when stroke size is large,
: anticoagulation would put patients on the risk of hemorrhagic transformation
: . What should we do?
: Here is a review article:
: http://stroke.ahajournals.org/content/38/2/423.long
: So we should not routinely anticoagulate acute stroke patients with a-fib.
: However, if patients are having crescendo TIAs, or found to have a cardiac
: thrombosis, etc, you may have to adjust your strategies.
| S**********e
发帖数: 1325 | 4 教授，感觉你拿我们这些东西当GRE阅读理解了，呵呵。赞热情！
【在 h*******l 的大作中提到】
: 好文章。
: 这篇文章的结果不支持在急性缺血性中风的患者早期使用抗凝血剂。
: 早期阿司匹林维生素K拮抗剂长期二级预防是更合理的选择。
: 总的来说，他们还是支持传统的保守治疗方法。但是如果遇到严重急性缺血性中风的患
: 者，可以使用肝素等抗凝血剂。
:
: atrial
: indicated
: transformation
:
| A*******s
发帖数: 9638 | 5 Great reading！ 赞
of
【在 S**********e 的大作中提到】
: Abstract
: Background and Purpose— The role of anticoagulant treatment for acute
: cardioembolic stroke is uncertain. We performed an updated meta-analysis of
: all randomized trials to obtain the best estimates of the efficacy and
: safety of anticoagulants for the initial treatment of acute cardioembolic
: stroke.
: Methods— Using electronic and manual searches of the literature, we
: identified randomized trials comparing anticoagulants (unfractionated
: heparin or low-molecular-weight heparin or heparinoids), started within 48
: hours, with other treatments (aspirin or placebo) in patients with acute
| A*******s
发帖数: 9638 | 6 我强烈怀疑教授LD是CMG了， lol
【在 h*******l 的大作中提到】
: 好文章。
: 这篇文章的结果不支持在急性缺血性中风的患者早期使用抗凝血剂。
: 早期阿司匹林维生素K拮抗剂长期二级预防是更合理的选择。
: 总的来说，他们还是支持传统的保守治疗方法。但是如果遇到严重急性缺血性中风的患
: 者，可以使用肝素等抗凝血剂。
:
: atrial
: indicated
: transformation
:
| h*******l
发帖数: 1542 | 7 您怎么没有怀疑我在自我改造？ I do not have a LD yet.
【在 A*******s 的大作中提到】
: 我强烈怀疑教授LD是CMG了， lol
| A*******s
发帖数: 9638 | 8 lol
what is 维生素K拮抗剂?
【在 h*******l 的大作中提到】
: 您怎么没有怀疑我在自我改造？ I do not have a LD yet.
| m********4
发帖数: 607 | 9 谢谢。
可否把【医读 1】改为【医读 Jan-12】方便本月末收集整理？
提议：所有推荐的文章前加【医读 －MM-YY】，主要为方便每月末的编辑。谢谢合作。
atrial
indicated
transformation
【在 A*******s 的大作中提到】
: Hospitalists like to give heparin drip for acute stroke patients with atrial
: fibrillation. This is a controversial topic. Anticoagulation is indicated
: for cardiac emboli and atrial fibrillation, but when stroke size is large,
: anticoagulation would put patients on the risk of hemorrhagic transformation
: . What should we do?
: Here is a review article:
: http://stroke.ahajournals.org/content/38/2/423.long
: So we should not routinely anticoagulate acute stroke patients with a-fib.
: However, if patients are having crescendo TIAs, or found to have a cardiac
: thrombosis, etc, you may have to adjust your strategies.
| c********n
发帖数: 651 | 10 is it warfarin??
【在 A*******s 的大作中提到】
: lol
: what is 维生素K拮抗剂?
| h*******l
发帖数: 1542 | 11 维生素K拮抗剂
【中文名】华法林
【英文名】Warfarin Sodium
【类别】血液系统药\抗凝血药
【别名】 苄丙酮香豆素钠;华法令钠;华福灵;苄酮香豆素钠 ,华法林钠,华法林,苄丙酮
香豆素
【外文名】Warfarin ,Warfarin Sodium, Athrombine, COUMADIN, PANAWARFIN,
WARFILONE,Coumadin
【药理作用及用途】 维生素K拮抗剂，可抑制肝合成有功能的凝血因子Ⅱ、Ⅶ、Ⅸ、X
。本品服后，2～7天起效，与肝素不同，在体外无抗凝作用。本品能通过胎盘，不通过
乳汁。 用于防治血栓栓塞性疾病。
【适应症】
1.防治血栓栓塞性疾病，可防止血栓形成与发展，如治疗血栓栓塞性静脉炎，降低肺栓
塞的发病率和死亡率，减少外科大手术，风湿性心脏病、髋关节固定术、人工置换心脏
瓣膜手术等的静脉血栓发生率。 2.心肌梗塞的辅助用药。 | A*******s
发帖数: 9638 | 12 我之所以写成【医读 1】是因为标题不能写太多， 毕竟题目是最重要的。 你可以每个
月整理一下， 我觉得不可能太多， 所以应该不是问题。
【在 m********4 的大作中提到】
: 谢谢。
: 可否把【医读 1】改为【医读 Jan-12】方便本月末收集整理？
: 提议：所有推荐的文章前加【医读 －MM-YY】，主要为方便每月末的编辑。谢谢合作。
:
: atrial
: indicated
: transformation
:
| n*******c
发帖数: 501 | 13 So when will you start anticoagulation therapy? | A*******s
发帖数: 9638 | 14 It depends. Some Docs start coumadin 2-3 days after the stroke. You have to
consider someone may need a G-tube so coumadin may not be started too early
. |
|
