抗凝固療法中, 脳内出血を合併した脳梗塞例

概要

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A case, 62 year old male, of brain infarction due to the right internal carotid artery occlusion was reported. Cerebral angiographies revealed severe arteriosclerosis, so anticoagulant (Warfarin) therapy combined with platelet antiagglutinating agent (Aspirin) was started prophylactically on the 10th day after the onset. The thrombotest values, measured by the method of Owren, were in the upper region (10-15%) of the therapeutic range (5-15%). On the 25th day his consciousness level suddenly deteriorated. CT scan revealed large thalamic hemorrhage near the infarcted brain tissue. On the next day the patient died.<BR>According to other reports the anticoagulant therapy should be started at least 10 days after the occurrence of the brain infarction. The complication of cerebral hemorrhage in anticoagulant therapy was rare. However the majority of hemorrhage in these patients arise when bleeding occurs in previously infarcted brain. Therefore prophylactic anticoagulant therapy after the brain infarction should be started at least four weeks or more after the onset when hemorrhagic infarction does not occur.
The Japanese Society on Surgery for Cerebral Strokeの論文