Anticoagulant therapy with heparin and warfarin for progressing stroke of the basilar artery territory.
スポンサーリンク
概要
- 論文の詳細を見る
In patients with basilar artery thrombosis, initial mild hemisensory or hemimotor deficits with dysarthria may predispose them to severe conditions (such as the locked-in state). Since most infarctions in the brainstem region are due to thrombotic occlusive disease of the basilar artery, anticoagulant therapy may be indicated in these patients when the initial deficit is mild.<BR>Five patients aged 56 to 77 years old who presented with a mild but progressing brainstem syndrome were treated with heparin within the first 12 hours of onset. Before heparin was administered, a CT scan was performed to rule out intracranial hemorrhage. An irregularly shaped ischemic lesion in the brainstem was found on CT or MRI scans in each case on the first day or later. An elevated blood pressure was carefully controlled. All of the patients were given an intravenous bolus of 5, 000 units of heparin followed by a constant daily infusion of 15, 000 units for 3 days. At the same time, warfarin (2 mg/day) was started. The desired anticoagulant level was a thrombotest result of 3040% of the control value after heparin was discontinued. Progression of the symptoms stopped immediately after the initiation of heparin, and gradually regressed thereafter. During the follow-up period of 6 months to 2 years, the patients become more independent in their activities of daily living and their prognosis seemed good. Warfarin was changed to an antiplatelet agent after 2 to 6 months in 4 patients. Hemorrhagic complications did not occur in any patient.<BR>The benefits of anticoagulant therapy have been demonstrated in several controlled trials of patients with brainstem stroke in evolution. Our results suggest that anticoagulant therapy may be promising if initiated in the early period of onset when the neurological deficit is mild. A CT scan should be performed to exclude hemorrhagic lesion and blood pressure must be controlled before and during this treatment. Anticoagulant therapy with heparin and warfarin has not been widely used in Japan except in the management of emboli of cardiac origin. However, the method described here caused no complications because heparin was given in a low dose for a short period. Every patient who was given heparin in the initial stage of thrombosis had a good prognosis. For progressing thrombotic stroke, especially in the basilar artery territory, anticoagulant therapy appeares to help prevent further progression.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
- Two cases with aphasia in the left putaminal damage and one case with visuospatial neglect in the right putaminal damage
- Alterations of plasma von Willebrand factor activity and the influence of anti-platelet drugs in acute cerebral infarction
- Carotid endarterectomy plaques correlation of clinical events and morphology.
- Stenting for stenosis of major cerebrovascular arteries.
- Cerebral infarction following antihypertensive therapy.