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对于服用新型口服抗凝剂的病人如何使用tPA:2013年缺血性脑卒中指南的建议
发布日期:2013-04-15

Title: tPA Use in Patients on New Oral Anticoagulants: Recommendations from the 2013 Ischemic Stroke Guidelines
题目:对于服用新型口服抗凝剂的病人如何使用tPA:2013年缺血性脑卒中指南的建议
Author作者: Bryan Hayes

A new recommendation in the 2013 Ischemic Stroke Guidelines provides guidance on what to do in patients taking new oral anticoagulants who are deemed eligible for IV fibrinolysis. Here is what the guidelines say:
2013年缺血性脑卒中治疗指南对适合使用静脉溶栓疗法的但服用新的口服抗凝剂的患者提供了一个新的建议。下面是指南在这一问题上的内容:
"The use of IV rtPA in patients taking direct thrombin inhibitors (dabigatran) or direct factor Xa inhibitors (rivaroxaban, apixaban) may be harmful and is not recommended unless sensitive laboratory tests such as aPTT, INR, platelet count, and ECT, TT, or appropriate direct factor Xa activity assays are normal, or the patient has not received a dose of these agents for >2 days (assuming normal renal metabolizing function)."
“在使用直接凝血酶抑制剂(达比加群)或直接Xa因子抑制剂(利伐沙班,阿哌沙班)的患者中静脉应用 rtPA可能是有害的,不建议使用。除非敏感的实验检查项目,如APTT,INR,血小板计数,ECT,TT,或适当的直接Xa因子活性测定,是正常的,或病人在2天内没有吃这些药物(假设病人肾代谢功能正常)。”
 
Additional points 要点:
The most helpful lab tests are not widely available.
许多有意义的实验室检查并不是普遍的。
A detailed history is important, but not always obtainable.
详细的病史是重要的,但并不是任何时候多可以得到的。

Until further data are available, a history consistent with recent use of new oral anticoagulants generally precludes use of IV tPA.
在有新的证据之前,近期服用新的口服抗凝药都要禁用静脉tPA。
References 参考文献:
Jauch EC, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.  Stroke 2013;44(3):870-947.