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題 名 | Anticoagulation in Acute Ischemic Stroke=急性腦梗塞之抗凝血劑療法 |
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作 者 | 盧玉強; 甄瑞興; 江冠華; 洪國華; 李介元; 翁文章; 胡漢華; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 3:2 2001.04[民90.04] |
頁 次 | 頁103-111 |
分類號 | 415.922 |
關鍵詞 | 急性腦梗塞; 傳統肝素; 低分子量肝素; 安全性及療效; Acute ischemic stroke; Standard heparin; Low-molecular-weight heparin; Safety and efficiency; |
語 文 | 英文(English) |
中文摘要 | 急性腦梗塞之治療新觀念是及時在3小時內把已栓塞之血管暢通,如果血管再次暢通恢復供血,則可有效地減少腦細胞的死亡。目前在急性腦梗塞之治療中,除使用血栓溶劑rTPA外,抗凝血劑之使用也具積極治療之意義。特別在急性腦梗塞發生後,病情仍在惡化時,使用抗凝血劑,有阻礙血液凝固,暢通血管及減少腦梗塞範圍之功能。抗凝血劑有傳統高分子量肝素Heparin和低分子量肝素Low Molecular Weight Heparin (LMWH)兩種,低分子量肝素有較不會引起出血慌副作用及不必靜脈注射之優點。本文利用此兩種肝治療急性腦梗塞及病情在48小時內仍在惡化之病例,並評估及比較兩者之安全性及療效。抗凝血劑在急性腦梗塞10天治療期間中,低分子量肝素與高分子量肝素,均具療效,都能提昇神經功能及自我照顧之指數,兩?之療效無差異性,發現4位(13.3%)有腦出血副作用,同樣狀況下,29位低分子量肝素使用者僅兩位(6.8%)有腦出血。因此對急性腦梗塞中仍在惡化者之治療,低分子量肝素及傳統肝素均有實際療效,但是低分子量肝素之腦出血作用較低。 |
英文摘要 | Objective: To determine whether low-molecular-weight heparin (LMWH) is more beneficial than standard heparin in the treatment of progressing ischemic stroke. Background: Although the efficacy and safety of standard heparin remain uncertain. Many physicians are antithrombotic agents to treat progressing stroke. Comparing with standard heparin, low-molecular-weight heparin (LMWH) has a longer plasma half-life., better bioavailability, less thrombocytopenia and less bleeding complication. Thus, this study was to determine whether LMWH is more beneficial than standard heparin in the treatment of progressive ischemic stroke. Method: From July 1997 through Jane 1999, 62 in-patients with progressing stroke were randomly assigned within 45 hours of onset of symptoms to receive subcutaneous LMWH (4,100 anti-factor Xa IU twice daily) or intravenous, continuous infusion of standard heparin (15,000 IU per day) for 10 days. Grade neurological scale and Barthel index were used to assess the outcome on the fourteenth and twenty-eight days. All patients required a second computerized tomography (CT) at the end of treatment period (tenty day) or anytime if the patient has getting worse. Result: After ten days of anticoagulant therapy, the total neurological scales and Barthel self care scores were increased in both LMWH and standard heparin groups. But we found no significant difference between the LMWH and standard heparin groups by suing Wilcoxon rank-sum test. A second CT scan was undergone by all patients. We found 4 (13.3%) of 30 patients had evidence of hemorrhagic transformation in the standard heparin group and 2 (6.8) of 29 patients in the LMWH group. Conclusion: We conclude that LMWH at dosage of 0.4 ml (4,100 anti-factor Xa IU) twice a day for ten days, is at least as effective as intravenous infusion of standard heparin at a dosage of 15,000 IU daily. LMWH and standard heparin are effective in treatment of progressing ischemic stroke but LMWH has less hemorrhagic transformation. |
本系統中英文摘要資訊取自各篇刊載內容。