文档介绍：阿加曲班与脑梗死
血栓形成机制示意图
缺血性卒中抗栓 特异性诊疗
抗 凝
溶 栓
抗血小板
急性脑梗死抗凝诊疗 作用机制
预防早期卒中复发
(再血栓栓塞)
阻止神经症状 恶化
(预防血栓延长)
改善卒中预后
(改善微循环和血供)
抗凝药品 作用靶点及发展历史
Ⅱa和Ⅹa 因子抑制剂
磺达肝素 iv（ATⅢ+Ⅹa）
1990年阿加曲班 iv （Ⅱa）
1980年低分子肝素 ih（ ATⅢ+Ⅹa +Ⅱa）
1940年华法令 ( Ⅱ,Ⅶ,Ⅸ,Ⅹ ,C,S)
1935年一般肝素 iv（ ATⅢ+Ⅹa +Ⅱa）
多靶点向单一靶点发展
抗凝药品 分类
进入美国新版指南
美国AHA/（ASA）最新急性缺血性卒中早期管理指南
Stroke. published online January 31, ;
美国指南相关抗凝药品诊疗 新推荐
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.
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
IIb / B
NEW
Stroke. published online January 31, ;
美国指南对直接凝血酶抑制剂 背景评论
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.
Stroke. published online January 31, ;
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 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 推荐意见。
美国指南对达比加群 背景介绍
Dabigatran, a direct thrombin inhibitor, has been evaluated over the past decade for the prevention of thromboembolic events in patients after orthopedic procedures.
More recently, in the RE-LY study (Randomized Evaluation of Long-term Anticoagulation Therapy), dabigatran demonstrated benefit compared with warfarin for the prevention of stroke or systemic embolization in patients with atrial fibrillation. At lower doses, dabigatran was noninferior to warfarin while demonstrating fewer hemorrhagic complications. At higher doses, dabigatran was more effective than warfarin but had similar bleeding risk.