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Cerebral hemorrhage is the most serious type of stroke, with the highest mortality and disability rate among survivors
.
Paradoxically, for surviving patients, cerebral hemorrhage can provide an opportunity to take measures to prevent the gradual deterioration of brain health over time
Cerebral hemorrhage is the most serious type of stroke, with the highest mortality and disability rate among survivors
Anti-coagulation, this is a problem.
However, many cases of cerebral hemorrhage more unfortunate: they suffer from atrial fibrillation, and therefore they are suffering from thrombotic risk of embolic stroke is also higher
Current research status Current research status
The current research on this issue includes observational research and decision-making analysis, but strong evidence from clinical trials is needed
.
A randomized trial of starting or stopping anticoagulant drugs (SoSTART) has been launched, and some results have been published
The current research on this issue includes observational research and decision-making analysis, but strong evidence from clinical trials is needed
Floris Schreuder and colleagues conducted a prospective, randomized, open-label Phase 2 trial (APACHE-AF) in 16 hospitals in the Netherlands to study the effects of apixaban and antiplatelet drugs after anticoagulation-related cerebral hemorrhage in patients with atrial fibrillation.
Kaplan-Meier chart of the risk of first non-fatal stroke or vascular death
.
.
The purpose of this trial is to investigate whether anticoagulant therapy (in this case, apixaban is used) after cerebral hemorrhage
.
Compared with not using anticoagulants, the incidence of the combined outcome of non-fatal stroke or vascular death is different
The purpose of this trial is to investigate whether anticoagulant therapy (in this case, apixaban is used) after cerebral hemorrhage
For these 101 participants, regardless of whether they received anticoagulation therapy or not, the annual event rate was more than 10% (12.
If you combine, you will win, if you divide, you will win if you combine, and if you divide, you will lose.
More and larger clinical trials are underway
There are still many problems that need to be solved to protect the brain health of survivors of cerebral hemorrhage
.
Careful and effective blood pressure control requires clinicians and even patients' families to pay attention to patients.
Careful and effective blood pressure control requires clinicians and even patients' families to pay attention to patients
.
Most of these patients have poor blood pressure control
.
For those patients who suffer from both cerebral hemorrhage and atrial fibrillation, doctors must provide thoughtful communication between doctors and patients
.
After cerebral hemorrhage, there is a clear balance in the anticoagulation treatment of atrial fibrillation.
Therefore, a large amount of communication and understanding may lead to the initiation or recovery of anticoagulation treatment
.
We still need to confirm whether this is more likely to be related to good or bad
.
Original source
Original source1.
Pasi M, Sugita L, Xiong L, et al.
Association of cerebral small vessel disease and cognitive decline after intracerebral hemorrhage.
Neurology.
2021; 96: e182–92.
Pasi M, Sugita L, Xiong L, et al.
Association of cerebral small vessel disease and cognitive decline after intracerebral hemorrhage.
Neurology.
2021; 96: e182–92.
2.
The Lancet Neurology.
A social dimension for brain health: the mounting pressure.
Lancet Neurol 2021; 20: 773.
The Lancet Neurology.
A social dimension for brain health: the mounting pressure.
Lancet Neurol 2021; 20: 773.
3.
SoSTART Collaboration.
Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage in the UK: a randomised, open-label, assessor-masked, pilot-phase, non-inferiority trial.
Lancet Neurol 2021; 20: 842–53.
SoSTART Collaboration.
Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage in the UK: a randomised, open-label, assessor-masked, pilot-phase, non-inferiority trial.
Lancet Neurol 2021; 20: 842–53.
4.
Schreuder FHBM, van Nieuwenhuizen KM, Hofmeijer J, et al.
Apixaban versus no anticoagulation after anticoagulation associated intracerebral haemorrhage in patients with atrial fibrillation in the Netherlands (APACHE-AF): a randomised, open-label, phase 2 trial.
Lancet Neurol.
2021; 20: 907–16.
Schreuder FHBM, van Nieuwenhuizen KM, Hofmeijer J, et al.
Apixaban versus no anticoagulation after anticoagulation associated intracerebral haemorrhage in patients with atrial fibrillation in the Netherlands (APACHE-AF): a randomised, open-label, phase 2 trial.
Lancet Neurol.
2021; 20: 907–16.
5.
Biffi A, Teo KC, Castello JP, et al.
Impact of uncontrolled hypertension at 3 months after intracerebral hemorrhage.
J Am Heart Assoc 2021;10: e020392.
Biffi A, Teo KC, Castello JP, et al.
Impact of uncontrolled hypertension at 3 months after intracerebral hemorrhage.
J Am Heart Assoc 2021;10: e020392.
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