[AF-FORUM] 198E 小脑内出血后的抗凝，Wee Siong医生

[AF Symposium]

198E 小脑内出血后的抗凝，Wee Siong医生

敬爱的同仁：

我想问一个有关患有如下问题的85岁男患者的处置意 
见：他有不稳定的收缩期高血压，有时收缩期血压高 
于180mmHg，但是偶尔有有症状的体位性和进食后的低 
血压；初发的阵发性房颤合并病窦综合征，后来植入 
起搏器，目前已进展为慢性房颤超过一年时间；冠脉 
造影证实为高冠脉钙化积分；然而腺苷MIBI扫描结果 
却为局部缺血阴性；高脂血症；中度的肾脏损伤。

该患者最初应用地高辛控制心室率，华法林抗凝，调 
节INR至1.5-2.0。他同时也在应用坎地沙坦，普萘洛尔 
和呋塞米。然而他发展成为小脑内出血，幸好情况尚 
稳定，没有进行神经外科的治疗。患者入院时INR仅仅 
1.34，这提示过分抗凝不是主要问题。问题是他能不 
能以及什么时候能开始抗凝治疗？还有一个问题就是 
如何控制这个非常不稳定的高血压。

肖明译

198E:Anticoagulation post intracerebellar hemorrhage. Dr. Wee Siong TEO
Dear colleagues

I will like to ask for comments on how to manage an 85 year old man  
who has the following problems：Labile systolic hypertension with  
episodes of systolic bp > 180 systolic at times but occasionally  
symptomatic postural and post-prandial hypotension. Initially  
paroxysmal AF with sick sinus syndrome and subsequently had pacemaker  
implanted but is now in chronic AF for more than 1 year. Coronary  
artery disease as documented by high coronary calcium score.  
Adenosine MIBI scan done was however negative for ischemia.  
Hyperlipidemia .Mild renal impairment. He was initially well  
controlled with digoxin rate control and warfarin anticoagulation  
with INR 1.5-2.0. He was also on Atacand, propranolol and frusemide.  
He however developed an episode of intra-cerebellar hemorrhage which  
fortunately is stable and did not require any neurosurgical  
intervention. The INR on admission was only 1.34 indicating that over- 
anticoagulation was not the main problem. The question is can and  
when should he be started on anticoagulation. Also is there any  
suggestions on how to control the very labile hypertension.

Thanks again

Dr Wee Siong TEO

Singapore


--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee