Title: tPA for Acute Ischemic Stroke Patients on Warfarin

题目：组织纤维蛋白溶酶原激活剂（tPA）在服用华法令病人患急性缺血性脑梗塞时的应用

Author 作者: Bryan Hayes

• IV alteplase (tPA) has many contraindications when administered for acute ischemic stroke. Among them is a history of warfarin use with INR > 1.7 (0-3 hours) or any history of warfarin use regardless of INR (3-4.5 hours).

• 静脉阿替普酶（tPA）在急性缺血性脑梗塞使用中有很多禁忌症，其中包括服用华法令并且INR超过1.7（0-3小时标准）或只要服用华法令不管INR的值（3-4.5小时标准）。

• A recent retrospective analysis of a major stroke registry compared the risk of symptomatic intracerebral hemorrhage (ICH) following tPA in patients on warfarin with an INR < 1.7 (n - 1,802) with patients not on warfarin therapy (n = 21,635).

• 最近发表了一个大规模脑卒中回顾性分析报告，对接受tPA治疗病人中有脑出血症状表现在服用华法令（INR低于1.7）和不服用华法令之间的差别进行了比较分析。

• After adjusting for differences in the two populations, the authors found no increased symptomatic ICH risk in patients with preadmission warfarin use (5.7% vs. 4.6%, p = 0.94).

• 在对两组调查人群的差别进行调整后，作者发现华法令的使用并没有明显增加有症状的颅内出血的倾向（5.7 ％对4.6％，p＝0.94）

Issue 1: Mean INR in study patients was only 1.22 (median 1.2). An INR of 1.2 represents very little actual anticoagulation.

问题1：研究组病人的INR只有1.22（平均1.2）。INR1.2只代表非常轻微的抗凝作用。

Issue 2: In the small subgroup of patients with INR 1.5 to 1.7 (n = 269) there was a higher risk of ICH (7.8%), but did not reach statistical significance (it was significant in the unadjusted risk population).

问题2：在INR1.5－1.7亚病人组中，虽然没有明显统计学上的差别，颅内出血率有增加（7.8％）。

Bottom line: Patients with INRs < 1.5 may be ok to receive tPA. Patients with INRs 1.5 or greater need further study.

要点：对INR小于1.5的病人可能没有问题接受tPA，但对于INR超过1.5的病人的安全性尚须进一步研究。

References 参考文献
Xian Y, Liang L, Smith EE, et al. Risk of Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Receiving Warfarin and Treated with Intravenous Tissue Plasminogen Activator. JAMA. 2012;307(24):2600-2608.