文档介绍：缺血性脑卒中抗凝治疗进展
直接凝血酶
抑制剂的崛起
LOGO
血栓形成机制示意图
血小板
血小板
ADP
激活
聚集
胶原
TXA2
凝血削a纤维蛋白原+纤维蛋白
组织凝血→凝血酶原址
因子瀑布
血栓
Pollack Cv, et al. The Journal of Emergency Medicine. 2008(344: 417-428
缺血性卒中抗栓的特异性治疗
抗凝
溶栓抗血小板
急性脑梗死抗凝治疗的作用机制
◆预防早期卒中复发
ophthalmic
(再血栓栓塞)
◆阻止神经症状的恶化
cerebellar
(防止血栓延长)
ant. int
◆改善卒中预后
(改善微循环和血供)
w
抗凝药物的作用靶点及发展历史
Ⅱa和Xa因子抑制剂
2002年磺达肝素iv(ATⅢ+Xa)
多靶点向单一靶点发展
1990年阿加曲班iv(la)
1980年低分子肝素ih(ATl+Xa+la)
(Ⅱ,Ⅶ,Ⅸ,X,C,S)
1935年普通肝素iv( ATII+ Xa+Ⅱla)
抗凝药物的分类
抗凝剂
凝血酶抑剂
Xa子抑制剂
其他
直接凝血丽抑制剂
问接凝血酶抑制剂
肝素
华法林
低分于肝秦
阿加曲班
肝素
利伐沙班
阿哌沙班
达比加群
低分了肝素
黄达肝葵钠
比伐卢淀定」
进入美国新版指南
2013年美国AHA/(ASA)最新急性缺
血性卒中早期管理指南
2007
年
9013
Stroke
Association
Stroke
二智
Stroke. published online January 31, 2013;
美国指南有关抗凝药物治疗的新推荐
v At present, the usefulness of argatroban or other thrombin
inhibitors for treatment of patients with acute ischemic
stroke is not well established. These agents should be used
in the setting of clinical trials
Ib/B
NEW
v The usefulness of urgent anticoagulation in patients with
severe stenos is of an internal carotid artery ipsilateral to
an ischemic stroke is not well established
IIb/B
NEW
Stroke. published online January 31, 2013
美国指南对直接凝血酶抑制剂的背景评论
v Direct thrombin inhibitors may be useful in acute
ischemic stroke because of their actions that limit
thrombosis. These medications could be considered as an
alternative to anticoagulants, and they could be
administered to those people who develop heparin
associated thrombocytopenia
首次将直接凝血酶抑制剂(阿加曲班、达比加群)写入美国指
南,以区分传统的间接凝血酶抑制剂(肝素、低分子肝素)。
单独对直接凝血酶抑制剂进行了介绍,并有新的推荐意见。
Stroke. published online January 31, 2013
美国指南对达比加群的背景介绍
V Dabigatran, a direct thrombin inhibitor, has been evaluated over the past
decade for the prevention of thromboembolic events in patients after
orthopedic procedures.
Y More recently, in the RE-LY study(Randomized Evaluation of Long
term Anticoagulation Therapy), dabigatran demon