脳血管障害-研究と診療の進歩(5) : 脳血管障害の凝血学的検査

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Various hemostatic tests are used to understand the mechanism of thrombus formation in cerebral infarction, and are useful for diagnosis and treatment of the infarction. Hemostatic markers show different patterns of abnormalities among the clinical categories of cerebral infarction, that is atherothrombotic, lacunar, and cardioembolic. The different patterns of abnormalities are suggested to reflect both the underlying pathophysiological mechanisms and the hemostatic activation induced by cerebral infarction itself. On the other hand, it is known that various hemostatic abnormalities can cause cerebral infarction. In particular, in patients who suffered cerebral infarction without atherosclerotic changes in their vessels, it is necessary to perform various hemostatic tests to investigate the etiology of the cerebral infarction. Hemostatic tests are also useful to monitor the intensity of antithrombotic therapy during the treatment of cerebral infarction. The international normalized ratio (INR) of prothrombin time is used as an index for anticoagulation with warfarin. The recommended INR level differs according to the underlying heart disease which caused the cerebral infarction. Contrary to anticoagulation, there is no established marker for antiplatelet therapy, but it is necessary to develop a method to monitor the intensity of recent potent antiplatelet therapy.

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