出血性卒中 DVT 比缺血性卒中 DVT 发生风险更高
自发性脑出血 DVT,应该怎么预防?
已发生下肢深静脉血栓
严重下肢动脉硬化、缺血
充血性心力衰竭、肺水肿、血栓性静脉炎
下肢局部严重病变如皮炎和坏疽、近期手术等。
中国血栓性疾病防治指南建议:不合并肿瘤的急性 DVT 的初始抗凝,推荐应用利伐沙班、达比加群酯或低分子肝素,达比加群给药前需给予初始胃肠外抗凝,利伐沙班给药前无需胃肠外抗凝。
研究显示利伐沙班可以达到与低分子肝素联合华法林同样的疗效,且并发大出血的概率低[10]。
低分子肝素桥接华法林(ACCP-10 指南建议在未选用新型口服抗凝剂时可次选该方案),两者联合应用 2-3 天待 INR 稳定于 2-3,并持续 24 小时后停用低分子肝素。华法林优于低分子肝素。
作者:马鞍山市中心医院神经内科 吴志勇
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