Expert consensus on multidisciplinary collaborative prevention and treatment of cardiogenic stroke in Jiangxi Province

doi:10.3877/cma.j.issn.2095-123X.2024.05.002

Abstract

Abstract:

Cardiovascular and cerebrovascular diseases are the leading causes of harm to human health and life， with the Jiangxi region located in a central area characterized by high incidence and mortality rates. Cardiogenic stroke （CES） accounts for 65% to 70% of all types of stroke. The prevention and treatment of CES are hindered by barriers between cardiology and neurology， and the diagnostic and treatment processes are not well standardized. This highlights the urgent need to optimize the current diagnosis and treatment procedures and improve specialized techniques， with a multidisciplinary and close cooperation system of“heart-brain treatment”. This consensus has been developed through the exploration of a series of scientific issues to guide clinical practice， promote the prevention and treatment of CES， and explore multidisciplinary collaborative diagnostic and treatment models. By leveraging a multidisciplinary， comprehensive diagnostic and treatment network， the aim is to establish a joint“screening-prevention-treatment”model across provincial，municipal，and county-level hospitals.

Key words: Cardiogenic stroke, Multidisciplinary team, Simultaneous treatment of heart and brain, Guideline

Quality Control Center of Jiangxi Province Neurosurgery. Expert consensus on multidisciplinary collaborative prevention and treatment of cardiogenic stroke in Jiangxi Province[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(05): 264-277.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhnkjbykfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-123X.2024.05.002

https://zhnkjbykfzz.cma-cmc.com.cn/EN/Y2024/V14/I05/264

Figures/Tables 3

References 97

［1］	Hart RG， Diener HC， Coutts SB， et al. Embolic strokes of undetermined source： the case for a new clinical construct［J］.Lancet Neurol， 2014， 13（4）： 429-438. DOI： 10.1016/s1474-4422（13）70310-7.
［2］	Zhao J，Liu R.Stroke 1-2-0：a rapid response programme for stroke in China［J］. Lancet Neurol， 2017， 16（1）： 27-28. DOI： 10. 1016/s1474-4422（16）30283-6.
［3］	于国栋，赵坤玉.急性脑卒中患者院前急救中急救护理的应用效果研究［J］.养生保健指南，2021，20（44）：167-168.Yu GD， Zhao KY. Study on the application effect of emergency nursing in prehospital emergency care for acute stroke patients［J］.Health Guide，2021，20（44）：167-168.
［4］	Lin CB，Peterson ED，Smith EE，et al.Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke［J］. Circ Cardiovasc Qual Outcomes， 2012， 5（4）： 514-522. DOI： 10.1161/circoutcomes.112.965210.
［5］	中国卒中学会急救医学分会.脑卒中院前急救专家共识［J］.全科医学临床与教育，2017，15（6）：604-609.DOI：10.13558/j.cnki.issn1672-3686.2017.06.002.Emergency Medicine Branch of Chinese Stroke School Association. Expert consensus on prehospital emergency care for stroke［J］.Clinical Education of General Practice，2017，15（6）：604-609.DOI：10.13558/j.cnki.issn1672-3686.2017.06.002.
［6］	中华医学会老年医学分会老年神经病学组，心源性卒中诊断中国专家共识撰写组. 心源性卒中诊断中国专家共识（2020）［J］.中华老年医学杂志，2020，39（12）：1369-1378.DOI：10.3760/cma.j.issn.0254-9026.2020.12.001.Chinese Expert Consensus Writing Group on Diagnosis of Cardiogenic Stroke； Geriatric Neuropathy， Geriatric Medicine Branch， Chinese Medical Association. Chinese experts' consensus on the diagnosis of cardiogenic stroke（2020）［J］. Chin J Geriatr，2020， 39（12）： 1369-1378. DOI： 10.3760/cma.j.issn.0254-9026.2020.12.001.
［7］	Zhang JB，Ding ZY，Yang Y，et al.Thrombolysis with alteplase for acute ischemic stroke patients with atrial fibrillation［J］. Neurol Res，2010，32（4）：353-358.DOI：10.1179/016164110x126563936 65206.
［8］	Moores M， Yogendrakumar V， Bereznyakova O， et al. Normal systolic blood pressure at presentation with acute ischemic stroke predicts cardioembolic etiology［J］. J Am Heart Assoc， 2020， 9（1）：e014399.DOI：10.1161/jaha.119.014399.
［9］	Seet RC， Zhang Y， Wijdicks EF， et al. Relationship between chronic atrial fibrillation and worse outcomes in stroke patients after intravenous thrombolysis［J］.Arch Neurol，2011，68（11）：1454-1458.DOI：10.1001/archneurol.2011.248.
［10］	Sader E， Abdalkader M， Thom N， et al. Endovascular treatment of infective endocarditis-related acute large vessel occlusion stroke［J］.J Stroke Cerebrovasc Dis，2021，30（6）：105775.DOI：10.1016/j.jstrokecerebrovasdis.2021.105775.
［11］	Xu T， Wang Y， Yuan J， et al. The effect of statin treatment on outcomes of cardioembolic stroke： a systematic review and metaanalysis of real-world studies［J］. CNS Drugs， 2021， 35（7）： 717-726.DOI：10.1007/s40263-021-00829-6.
［12］	中国卒中学会，中国卒中学会神经介入分会，中华预防医学会卒中预防与控制专业委员会介入学组.急性缺血性卒中血管内治疗中国指南2023［J］.中国卒中杂志，2023，18（6）：684-711.DOI：10.3969/j.issn.1673-5765.2023.06.010.Chinese Stroke Society； Neurological Intervention Branch of Chinese Stroke Society. Interventional Group of Stroke Prevention and Control Professional Committee of Chinese Preventive Medical Association. Chinese guidelines for endovascular treatment of acute ischemic stroke 2023［J］. Chin J Stroke， 2023， 18（6）： 684-711.DOI：10.3969/j.issn.1673-5765.2023.06.010.
［13］	中华医学会心血管病学分会，中国生物医学工程学会心律分会. 心房颤动诊断和治疗中国指南［J］. 中华心血管病杂志，2023， 51（6）： 572-618. DOI： 10.3760/cma.j.cn112148-20230416-00221.Chinese Society of Cardiology； Chinese Medical Association；Heart Rhythm Committee of Chinese Society of Biomedical Engineering. Chinese guidelines on diagnosis and management of atrial fibrillation［J］. Chin J Cardiol， 2023， 51（6）： 572-618. DOI：10.3760/cma.j.cn112148-20230416-00221.
［14］	Shen AY， Yao JF， Brar SS， et al. Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation［J］. J Am Coll Cardiol， 2007， 50（4）： 309-315. DOI：10.1016/j.jacc.2007.01.098.
［15］	Hylek EM， Ko D， Cove CL. Gaps in translation from trials to practice： non-vitamin K antagonist oral anticoagulants （NOACs）for stroke prevention in atrial fibrillation［J］. Thromb Haemost，2014，111（5）：783-788.DOI：10.1160/th13-12-1032.
［16］	Ikeda T， Ogawa S， Kitazono T， et al. Real-world outcomes of the Xarelto post - authorization safety & effectiveness study in Japanese patients with atrial fibrillation （XAPASS）［J］. J Cardiol，2019，74（1）：60-66.DOI：10.1016/j.jjcc.2019.01.001.
［17］	Kim YH， Shim J， Tsai CT， et al. Xanap： a real-world， prospective，observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation in Asia［J］. J Arrhythm， 2018， 34（4）：418-427.DOI：10.1002/joa3.12073.
［18］	Lip GYH，Banerjee A，Boriani G，et al.Antithrombotic therapy for atrial fibrillation： chest guideline and expert panel report［J］.Chest， 2018， 154（5）： 1121-1201. DOI： 10.1016/j.chest.2018.07.040.
［19］	Chiang CE， Okumura K， Zhang S， et al. 2017 consensus of the Asia pacific heart rhythm society on stroke prevention in atrial fibrillation［J］. J Arrhythm， 2017， 33（4）： 345-367. DOI： 10.1016/j.joa.2017.05.004.
［20］	Tsivgoulis G， Lioutas VA， Varelas P， et al. Direct oral anticoagulant - vs vitamin K antagonist - related nontraumatic intracerebral hemorrhage［J］. Neurology，2017，89（11）： 1142-1151.DOI：10.1212/wnl.0000000000004362.
［21］	Apostolaki-Hansson T， Ullberg T， Norrving B， et al. Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment［J］. Acta Neurol Scand， 2019， 139（5）： 415-421. DOI：10.1111/ane.13068.
［22］	Gerner ST，Kuramatsu JB，Sembill JA，et al.Characteristics in nonvitamin K antagonist oral anticoagulant - related intracerebral hemorrhage［J］. Stroke， 2019， 50（6）： 1392-1402. DOI： 10.1161/strokeaha.118.023492.
［23］	Steffel J， Verhamme P， Potpara TS， et al. The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation［J］.Eur Heart J，2018，39（16）：1330-1393.DOI：10.1093/eurheartj/ehy136.
［24］	Yaghi S， Boehme AK， Dibu J， et al. Treatment and outcome of thrombolysis-related hemorrhage：a multicenter retrospective study［J］.JAMANeurol，2015，72（12）：1451-1457.DOI：10.1001/jamaneurol.2015.2371.
［25］	Majeed A， Kim YK， Roberts RS， et al. Optimal timing of resumption of warfarin after intracranial hemorrhage［J］. Stroke，2010，41（12）：2860-2866.DOI：10.1161/strokeaha.110.593087.
［26］	Claassen DO， Kazemi N， Zubkov AY， et al. Restarting anticoagulation therapy after warfarin - associated intracerebral hemorrhage［J］. Arch Neurol， 2008， 65（10）： 1313-1318. DOI： 10.1001/archneur.65.10.1313.
［27］	Kernan WN， Ovbiagele B， Black HR， et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack： a guideline for healthcare professionals from the American Heart Association/American Stroke Association［J］. Stroke， 2014，45（7）：2160-2236.DOI：10.1161/str.0000000000000024.
［28］	Powers WJ， Rabinstein AA， Ackerson T， et al. Guidelines for the early management of patients with acute ischemic stroke： 2019 update to the 2018 guidelines for the early management of acute ischemic stroke： a guideline for healthcare professionals from the American Heart Association/American Stroke Association［J］.Stroke，2019，50（12）：e344-e418.DOI：10.1161/str.0000000000 000211.
［29］	Senoo K， Proietti M， Lane DA， et al. Evaluation of the HASBLED， ATRIA， and ORBIT bleeding risk scores in patients with atrial fibrillation taking warfarin［J］.Am J Med，2016，129（6）：600-607.DOI：10.1016/j.amjmed.2015.10.001.
［30］	Hart RG， Pearce LA， Aguilar MI. Meta-analysis： antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation［J］. Ann Intern Med， 2007， 146（12）： 857-867. DOI： 10.7326/0003-4819-146-12-200706190-00007.
［31］	Giugliano RP， Ruff CT， Braunwald E， et al. Edoxaban versus warfarin in patients with atrial fibrillation［J］. N Engl J Med， 2013，369（22）：2093-2104.DOI：10.1056/NEJMoa1310907.
［32］	Patel MR， Mahaffey KW， Garg J， et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation［J］. N Engl J Med， 2011，365（10）：883-891.DOI：10.1056/NEJMoa1009638.
［33］	Granger CB， Alexander JH， McMurray JJ， et al. Apixaban versus warfarin in patients with atrial fibrillation［J］. N Engl J Med， 2011，365（11）：981-992.DOI：10.1056/NEJMoa1107039.
［34］	Connolly SJ， Ezekowitz MD， Yusuf S， et al. Dabigatran versus warfarin in patients with atrial fibrillation［J］. N Engl J Med， 2009，361（12）：1139-1151.DOI：10.1056/NEJMoa0905561.
［35］	Avezum A， Lopes RD， Schulte PJ， et al. Apixaban in comparison with warfarin in patients with atrial fibrillation and valvular heart disease： findings from the apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation （ARISTOTLE）trial［J］. Circulation， 2015， 132（8）： 624-632. DOI： 10.1161/circulationaha.114.014807.
［36］	Ezekowitz MD， Nagarakanti R， Noack H， et al. Comparison of dabigatran and warfarin in patients with atrial fibrillation and valvular heart disease： the RE-LY trial （randomized evaluation of long-term anticoagulant therapy）［J］. Circulation， 2016， 134（8）：589-598.DOI：10.1161/circulationaha.115.020950.
［37］	Clay-Weinfeld K， Callans M. Common postcardiothoracic surgery arrhythmias［J］. Crit Care Nurs Clin North Am， 2019， 31（3）： 367-388.DOI：10.1016/j.cnc.2019.05.006.
［38］	Stroke Prevention in Atrial Fibrillation Investigators. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation： Stroke prevention in atrial fibrillation Ⅱstudy［J］.Lancet，1994，343（8899）：687-691.DOI：10.1016/S0140-6736（94）91577-6.
［39］	Connolly S，Pogue J，Hart R，et al.Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events（ACTIVE W）： a randomised controlled trial［J］. Lancet， 2006， 367（9526）：1903-1912.DOI：10.1016/s0140-6736（06）68845-4.
［40］	van Rein N， Heide-Jørgensen U， Lijfering WM， et al. Major bleeding rates in atrial fibrillation patients on single， dual， or triple antithrombotic therapy［J］. Circulation， 2019， 139（6）： 775-786.DOI：10.1161/circulationaha.118.036248.
［41］	Reddy VY，Doshi SK，Kar S，et al.5-year outcomes after left atrial appendage closure： erom the PREVAIL and PROTECT AF trials［J］. J Am Coll Cardiol， 2017， 70（24）： 2964-2975. DOI： 10.1016/j.jacc.2017.10.021.
［42］	Osmancik P， Herman D， Neuzil P， et al. Left atrial appendage closure versus direct oral anticoagulants in high-risk patients with atrial fibrillation［J］. J Am Coll Cardiol， 2020， 75（25）： 3122-3135.DOI：10.1016/j.jacc.2020.04.067.
［43］	Tzikas A， Shakir S， Gafoor S， et al. Left atrial appendage occlusion for stroke prevention in atrial fibrillation： multicentre experience with the AMPLATZER cardiac plug［J］. EuroIntervention，2016，11（10）：1170-1179.DOI：10.4244/eijy 15m01_06.
［44］	Phillips KP， Pokushalov E， Romanov A， et al. Combining watchman left atrial appendage closure and catheter ablation for atrial fibrillation： multicentre registry results of feasibility and safety during implant and 30 days follow-up［J］. Europace， 2018，20（6）：949-955.DOI：10.1093/europace/eux183.
［45］	Heeger CH， Rillig A， Geisler D， et al. Left atrial appendage isolation in patients not responding to pulmonary vein isolation［J］.Circulation， 2019， 139（5）： 712-715. DOI： 10.1161/circulationaha.118.037451.
［46］	Schwann TA， Vekstein AM， Engelman DT， et al. Long - term outcomes and anticoagulation in mitral valve surgery-a report from the society of thoracic surgeons database［J］. Ann Thorac Surg，2023，116（5）：944-953.DOI：10.1016/j.athoracsur.2023.05.025.
［47］	张春曦，黄达德.单叶和双叶机械瓣置换术后抗凝治疗的临床对比［J］.岭南心血管病杂志，2004，10（1）：35-37.DOI：10.3969/j.issn.1007-9688.2004.01.009.Zhang CX， Huang DD. A clinical comparative study on effects of anticoagulation therapy for the patients implanted unileaflet or bileafiet mechanical prosthetic valves［J］. South China Journal of Cardiovascular Diseases，2004，10（1）：35-37.DOI：10.3969/j.issn.1007-9688.2004.01.009.
［48］	Thourani VH， Gunter RL， Hurst S， et al. Postoperative warfarin following mitral valve repair or bioprosthetic valve replacement［J］.J Heart Valve Dis，2013，22（5）：716-723.
［49］	Ailawadi G， Gerdisch MW， Harvey RL， et al. Exclusion of the left atrial appendage with a novel device：early results of a multicenter trial［J］. J Thorac Cardiovasc Surg， 1002-1009， 1009.e1. DOI： 10.1016/j.jtcvs.2011.07.052.
［50］	于洋，谷天祥，师恩祎，等.右胸小切口微创二尖瓣手术同期行心房颤动双心房射频消融术［J］.中国胸心血管外科临床杂志，2015，22（2）：168-170.DOI：10.7507/1007-4848.20150046.Yu Y， Gu TX， Shi EY， et al. Simultaneous biventricular radiofrequency ablation of atrial fibrillation with minimally invasive mitral valve surgery through a small right thoracic incision［J］. Chin J Clin Thorac Cardiov Surg， 2015， 22（2）： 168-170.DOI：10.7507/1007-4848.20150046.
［51］	Rhee Y， Park SJ， Lee JW. Epicardial left atrial appendage clip occlusion in patients with atrial fibrillation during minimally invasive cardiac surgery［J］. J Thorac Cardiovasc Surg， 2023， 166（2）：468-474.DOI：10.1016/j.jtcvs.2021.10.032.
［52］	Lubetsky A， Shasha Y， Olchovsky D， et al. Impact of pre -treatment INR level on the effect of intravenous low dose vitamin K in patients with excessive anticoagulation［J］. Thromb Haemost，2003，90（1）：71-76.
［53］	Nombela-Franco L， Webb JG， de Jaegere PP， et al. Timing，predictive factors， and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation［J］. Circulation， 2012， 126（25）： 3041-3053. DOI： 10.1161/circulationaha.112.110981.
［54］	Auffret V， Regueiro A， Del Trigo M， et al. Predictors of early cerebrovascular events in patients with aortic stenosis undergoing transcatheter aortic valve replacement［J］. J Am Coll Cardiol，2016，68（7）：673-684.DOI：10.1016/j.jacc.2016.05.065.
［55］	特日格乐，侯昌，刘传芬，等.经导管主动脉瓣置入术后抗栓治疗研究进展［J］.中国心血管病研究，2023，21（4）：294-299.DOI：10.3969/j.issn.1672-5301.2023.04.002.Teri GL， Hou C， Liu CF， et al. Research progress of antithrombotic therapy after transcatheter aortic valve implantation［J］. Chinese Journal of Cardiovascular Research，2023， 21（4）： 294-299. DOI： 10.3969/j.issn.1672-5301.2023.04.002.
［56］	刘日霞，刘广志.提高心源性卒中的诊治水平：任重而道远［J］.中华医学杂志， 2022， 102（45）： 3559-3562. DOI： 10.3760/cma.j.cn112137-20220427-00948.Liu RX，Liu GZ.Improving the diagnosis and treatment of cardiac stroke：a long way to go［J］.Natl Med J China，2022，102（45）：3559-3562.DOI：10.3760/cma.j.cn112137-20220427-00948.
［57］	Pant S， Patel NJ， Deshmukh A， et al. Trends in infective endocarditis incidence， microbiology， and valve replacement in the United States from 2000 to 2011［J］. J Am Coll Cardiol， 2015，65（19）：2070-2076.DOI：10.1016/j.jacc.2015.03.518.
［58］	Habib G， Erba PA， Iung B， et al. Clinical presentation， aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO - ENDO （European infective endocarditis） registry： a prospective cohort study［J］.Eur Heart J，2019，40（39）：3222-3232.DOI：10.1093/eurheartj/ehz620.
［59］	Ambrosioni J， Hernandez - Meneses M， Téllez A， et al. The changing epidemiology of infective endocarditis in the twenty-first century［J］. Curr Infect Dis Rep， 2017， 19（5）： 21. DOI： 10.1007/s11908-017-0574-9.
［60］	Kiefer T， Park L， Tribouilloy C， et al. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure［J］. JAMA， 2011， 306（20）：2239-2247.DOI：10.1001/jama.2011.1701.
［61］	Baddour LM， Wilson WR， Bayer AS， et al. Infective endocarditis in adults： diagnosis， antimicrobial therapy， and management of complications： a scientific statement for healthcare professionals from the American Heart Association［J］. Circulation， 2015， 132（15）：1435-1486.DOI：10.1161/cir.0000000000000296.
［62］	Thornhill MH， Crum A， Campbell R， et al. Temporal association between invasive procedures and infective endocarditis［J］. Heart，2023，109（3）：223-231.DOI：10.1136/heartjnl-2022-321519.
［63］	Duval X， Millot S， Chirouze C， et al. Oral streptococcal endocarditis， oral hygiene habits， and recent dental procedures： a case-control study［J］. Clin Infect Dis， 2017， 64（12）： 1678-1685.DOI：10.1093/cid/cix237.
［64］	Lockhart PB， Brennan MT， Thornhill M， et al. Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia［J］. J Am Dent Assoc， 2009， 140（10）： 1238-1244. DOI： 10.14219/jada.archive.2009.0046.
［65］	Sy RW， Kritharides L. Health care exposure and age in infective endocarditis：results of a contemporary population-based profile of 1536 patients in Australia［J］. Eur Heart J， 2010， 31（15）： 1890-1897.DOI：10.1093/eurheartj/ehq110.
［66］	Glauser MP， Francioli P. Relevance of animal models to the prophylaxis of infective endocarditis［J］. J Antimicrob Chemother，1987，20 Suppl A：87-98.DOI：10.1093/jac/20.suppl_a.87.
［67］	Overholser CD， Moreillon P， Glauser MP. Experimental bacterial endocarditis after dental extractions in rats with periodontitis［J］. J Infect Dis，1987，155（1）：107-112.DOI：10.1093/infdis/155.1.107.
［68］	Richey R， Wray D， Stokes T. Prophylaxis against infective endocarditis：summary of nice guidance［J］.BMJ，2008，336（7647）：770-771.DOI：10.1136/bmj.39510.423148.AD.
［69］	Dayer MJ， Jones S， Prendergast B， et al. Incidence of infective endocarditis in England， 2000-13： a secular trend， interrupted time-series analysis［J］.Lancet，2015，385（9974）：1219-1228.DOI：10.1016/s0140-6736（14）62007-9.
［70］	Chakraborty T，Scharf E，DeSimone D，et al.Variable significance of brain MRI findings in infective endocarditis and its effect on surgical decisions［J］. Mayo Clin Proc， 2019， 94（6）： 1024-1032.DOI：10.1016/j.mayocp.2018.09.015.
［71］	Kume Y， Fujita T， Fukushima S， et al. Intracranial mycotic aneurysm is associated with cerebral bleeding post-valve surgery for infective endocarditis［J］. Interact Cardiovasc Thorac Surg，2018，27（5）：635-641.DOI：10.1093/icvts/ivy126.
［72］	Musleh R， Schlattmann P， Caldonazo T， et al. Surgical timing in patients with infective endocarditis and with intracranial hemorrhage：a systematic review and meta-analysis［J］.J Am Heart Assoc，2022，11（10）：e024401.DOI：10.1161/jaha.121.024401.
［73］	Yoshioka D， Toda K， Sakaguchi T， et al. Valve surgery in active endocarditis patients complicated by intracranial haemorrhage：the influence of the timing of surgery on neurological outcomes［J］.Eur J Cardiothorac Surg， 2014， 45（6）： 1082-1088. DOI： 10.1093/ejcts/ezt547.
［74］	中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018［J］.中华神经科杂志，2018，51（9）：666-682.DOI：10.3760/cma.j.issn.1006-7876.2018.09.004.Chinese Society of Neurology； Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018［J］. Chin J Neurol， 2018， 51（9）： 666-682. DOI： 10.3760/cma.j.issn.1006-7876.2018.09.004.
［75］	Barber PA，Wu TY，Ranta A.Stroke reperfusion therapy following dabigatran reversal with idarucizumab in a national cohort［J］.Neurology， 2020， 94（19）： e1968-e1972. DOI： 10.1212/wnl.00000 00000009155.
［76］	Toyoda K， Yamagami H， Koga M. Consensus guides on stroke thrombolysis for anticoagulated patients from Japan：application to other populations［J］.J Stroke，2018，20（3）：321-331.DOI：10.5853/jos.2018.01788.
［77］	Nadji G， Rusinaru D， Rémadi JP， et al. Heart failure in left-sided native valve infective endocarditis： characteristics， prognosis， and results of surgical treatment［J］.Eur J Heart Fail，2009，11（7）：668-675.DOI：10.1093/eurjhf/hfp077.
［78］	Pericàs JM， Hernández - Meneses M， Muñoz P， et al.Characteristics and outcome of acute heart failure in infective endocarditis： focus on cardiogenic shock［J］. Clin Infect Dis， 2021，73（5）：765-774.DOI：10.1093/cid/ciab098.
［79］	Thuny F， Beurtheret S， Mancini J， et al. The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis： a propensity analysis［J］. Eur Heart J，2011，32（16）：2027-2033.DOI：10.1093/eurheartj/ehp089.
［80］	Anguera I， Miro JM， Cabell CH， et al. Clinical characteristics and outcome of aortic endocarditis with periannular abscess in the international collaboration on endocarditis merged database［J］.Am J Cardiol，2005，96（7）：976-981.DOI：10.1016/j.amjcard.2005.05.056.
［81］	Handa K， Yoshioka D， Toda K， et al. Surgical results for infective endocarditis complicated with cardiogenic shock［J］. Circ J， 2020，84（6）：926-934.DOI：10.1253/circj.CJ-19-0583.
［82］	Lee VH， Connolly HM， Brown RD， Jr. Central nervous system manifestations of cardiac myxoma［J］. Arch Neurol， 2007， 64（8）：1115-1120.DOI：10.1001/archneur.64.8.1115.
［83］	Chojdak-Łukasiewicz J， Budrewicz S， Waliszewska-Prosół M.Cerebral aneurysms caused by atrial myxoma-a systematic review of the literature［J］. J Pers Med， 2022， 13（1）. DOI： 10.3390/jpm 13010008.
［84］	Saad EA， Mukherjee T， Gandour G， et al. Cardiac myxomas：causes， presentations， diagnosis， and management［J］. Ir J Med Sci，2024，193（2）：677-688.DOI：10.1007/s11845-023-03531-2.
［85］	Hagen PT， Scholz DG， Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life： an autopsy study of 965 normal hearts［J］.Mayo Clin Proc，1984，59（1）：17-20.DOI：10.1016/s0025-6196（12）60336-x.
［86］	Mac Grory B， Ohman EM， Feng W， et al. Advances in the management of cardioembolic stroke associated with patent foramen ovale［J］. BMJ， 2022， 376： e063161. DOI： 10.1136/bmj-2020-063161.
［87］	Elgendy AY， Saver JL， Amin Z， et al. Proposal for updated nomenclature and classification of potential causative mechanism in patent foramen ovale-associated stroke［J］. JAMA Neurol， 2020，77（7）：878-886.DOI：10.1001/jamaneurol.2020.0458.
［88］	Tripodi A， Mannucci PM. The coagulopathy of chronic liver disease［J］. N Engl J Med， 2011， 365（2）： 147-156. DOI： 10.1056/NEJMra1011170.
［89］	Potpara TS， Lip GY. Drug - induced liver injury with oral anticoagulants：a threat or not？［J］.Heart，2017，103（11）：809-811.DOI：10.1136/heartjnl-2016-310983.
［90］	冯瑞江，熊爱珍，梁佳，等.心房颤动伴肝功能不全患者口服抗凝药物的合理使用［J］. 临床心血管病杂志， 2019， 35（2）： 187-192.DOI：10.13201/j.issn.1001-1439.2019.02.021.Feng RJ， Xiong AZ， Liang J， et al. Rational use of oral anticoagulants in patients with atrial fibrillation and hepatic dysfunction［J］.J Clin Cardiol，2019，35（2）：187-192.DOI：10.13201/j.issn.1001-1439.2019.02.021.
［91］	Hohnloser SH， Hijazi Z， Thomas L， et al. Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation： insights from the aristotle trial［J］.Eur Heart J， 2012， 33（22）： 2821-2830. DOI： 10.1093/eurheartj/ehs274.
［92］	张卫芳，熊爱珍，程晓曙.心房颤动合并慢性肾脏疾病患者口服抗凝的治疗策略［J］. 临床心血管病杂志， 2019， 35（3）： 285-290.DOI：10.13201/j.issn.1001-1439.2019.03.021.Zhang WF， Xiong AZ， Cheng XS. Oral anticoagulation therapy in patients with atrial fibrillation and concomitant chronic kidney disease［J］.J Clin Cardiol，2019，35（3）：285-290.DOI：10.13201/j.issn.1001-1439.2019.03.021.
［93］	Ambrosy AP， Fonarow GC， Butler J， et al. The global health and economic burden of hospitalizations for heart failure： lessons learned from hospitalized heart failure registries［J］. J Am Coll Cardiol，2014，63（12）：1123-1133.DOI：10.1016/j.jacc.2013.11.053.
［94］	武丹威，韩爽，施楠楠，等.临床药师主导的慢性病管理在提高老年高血压患者对药物了解程度方面的作用［J］.中国药房，2018，29（23）：3251-3254.DOI：10.6039/j.issn.1001-0408.2018.23.18.Wu DW， Han S， Shi NN， et al. Effects of clinical pharmacist-led chronic disease management on the improvement of drug understanding in elderly hypertensive patients［J］. China Pharm，2018，29（23）：3251-3254.DOI：10.6039/j.issn.1001-0408.2018.23.18.
［95］	饶兰兰，马添翼.临床药师参与慢性心力衰竭患者慢病管理的效果评价［J］. 中国药房， 2020， 31（6）： 745-750. DOI： 10.6039/j.issn.1001-0408.2020.06.21.Rao LL， Ma TY. Effect evaluation of clinical pharmacists participating in chronic disease management for chronic heart failure patients［J］. China Pharm， 2020， 31（6）： 745-750. DOI： 10.6039/j.issn.1001-0408.2020.06.21.
［96］	Al-Qahtani S，Jalal Z，Paudyal V，et al.The role of pharmacists in providing pharmaceutical care in primary and secondary prevention of stroke： a systematic review and meta-analysis［J］.Healthcare （Basel）， 2022， 10（11）： 2315. DOI： 10.3390/healthcare 10112315.
［97］	Firat O， Arsava EM， Togay-Isikay C， et al. Clinical pharmacist's contribution to treatment adherence and quality of life in patients with stroke［J］. Brain Inj， 2023， 37（2）： 134-139. DOI： 10.1080/02699052.2023.2165154.

抗凝药物	肾功能（肌酐清除率）
抗凝药物	轻度（＞60 mL/min）	中度（30～59 mL/min）	重度（15～29 mL/min）	终末期（未透析）	透析
华法林	根据国际标准化比值调整剂量
达比加群酯	110-150 mg bid	75/150 mg bid	75 mg bid	禁用	禁用
利伐沙班	20 mg qn	15 mg qn	15 mg qn	10 mg qn	10 mg qn
阿哌沙班	2.5/5 mg bid	2.5/5 mg bid	2.5/5 mg bid	2.5/5 mg bid	2.5/5 mg bid

抗凝药物	肾功能（肌酐清除率）
抗凝药物	轻度（＞60 mL/min）	中度（30～59 mL/min）	重度（15～29 mL/min）	终末期（未透析）	透析
华法林	根据国际标准化比值调整剂量
达比加群酯	110-150 mg bid	75/150 mg bid	75 mg bid	禁用	禁用
利伐沙班	20 mg qn	15 mg qn	15 mg qn	10 mg qn	10 mg qn
阿哌沙班	2.5/5 mg bid	2.5/5 mg bid	2.5/5 mg bid	2.5/5 mg bid	2.5/5 mg bid

[1]	Jingyu Qian, Mingming Zheng. Interpretation of the Italian guidelines on non-invasive and invasive prenatal diagnosis：executive summary of recommendations for practice the Italian Society for Obstetrics and Gynecology（SIGO） [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 486-492.
[2]	Shixuan Qi, Lianguo Ruan. Research progress on rapid initiation of antiretroviral therapy for human immunodeficiency virus infection and model exploration [J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(04): 193-199.
[3]	Branch of Organ Transplant of China Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association. Chinese guidelines for minimally invasive surgical technique in living donor liver transplantation (2024 edition) [J]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(04): 241-252.
[4]	Yu Wang, Fangquan Xu, Xuan Zhou, Xiaofeng Yao, Qiang Li. Improve the standardization of radical resection of differentiated thyroid cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 473-476.
[5]	of Organ Transplantation of Chinese Medical Association Branch. Guideline for surgical techniques for deceased donor kidney procurement [J]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(05): 257-265.
[6]	Long Zhang, Shanke Sun, Wei Xu, Wenzhu Li, Junda Li, Yongquan Chi, Guangsheng He, Feng Cheng, Xuehao Wang, Jianhua Rao. Clinical efficacy of laparoscopic splenectomy in the treatment of hematological diseases [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 870-875.
[7]	Chinese Society of Organ Transplantation of Chinese Medical Association, Surgery Group of Chinese Society of Surgery of Chinese Medical Association, Transplantation Group of Chinese Society of Surgery of Chinese Medical Association, South China Alliance of Split Liver Transplantation. Chinese Clinical Practice Guidelines on Split Liver Transplantation in Children [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 593-601.
[8]	Department of Medical Administration of National Health Commission. Guidelines for diagnosis and treatment of primary liver cancer (2024) [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(04): 407-449.
[9]	Anti-Cancer Association China, Committee of Colorectal Cancer CACA the. CACA guidelines for holistic integrative management of anal cancer （2024 Edition） [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(06): 441-449.
[10]	Anti-cancer Association Colorectal Tumor Integrated Rehabilitation Committee， Neoadjuvant Therapy for Rectal Cancer Professional Committee of Beijing Cancer Prevention & Treatment Society Chinese. Guidelines on prevention，diagnosis，and treatment of nausea and vomiting caused by neoadjuvant therapies for rectal cancer [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(05): 353-361.
[11]	Xuefeng Zhou, Zheyi Dong, Zhe Feng, Guangyan Cai, Xiangmei Chen. Formulation protocol of guidelines for diagnosis and treatment of diabetic kidney disease with integrated traditional Chinese and Western medicine [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2024, 13(06): 301-305.
[12]	Yanping Liang, Yanrou Chen, Yunxiao Liang, Feihu Bai, Bin Wu, Xing Wang. Investigation report on endoscopic management of esophagogastric variceal bleeding in portal hypertension in Southern China [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 390-395.
[13]	Maojun Li, Binzhi Tang, Qing Wu, Qian Yang, Xiaoming Liang, Fulan Zou, Rong Huang, Changhui Chen. Management of neonatal respiratory distress syndrome: a brief introduction and evaluation of multinational guidelines/consensuses and RDS-NExT workshop consensus statements [J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(07): 607-617.
[14]	Nanqi Zhao, Xiaodong Wu, Dongxiao Mu, Nan Ding, Jing Hu. Analyzing the value of ancient clinicians' experience in acupuncture-moxibustion clinical practice guidelines [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2024, 13(04): 140-144.
[15]	Qin Li, Wei Mo, Bifang Zhou, Yulian Li, Xiuchun Yang. Construction of health problem list for patient guide after percutaneous hepatic puncture biliary drainage [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2024, 12(04): 386-391.

Please choose a citation manager

Content to export