每日一题_2022.3.27

A 44-year-old woman with a history of prior stroke and atrial fibrillation, and who takes dabigatran for anticoagulation, is admitted to the hospital for management of a large intracerebral hemorrhage, shown below. She is intubated for lethargy and admitted to the ICU. Vital signs are: blood pressure 175/98 mm Hg, heart rate 108 beats/min, respiratory rate 22 breaths/min, and temperature 36.7°C (98°F). Her Glasgow Coma Scale score is 7.

Which of the following treatments is most appropriate?

A. Idarucizumab

B. Prothrombin complex concentrate 

C. VitaminK

D. Factor VII

E. Freshfrozen plasma

答案解析：

该患者在使用直接凝血酶抑制剂（达比加群）抗凝的情况下发生脑出血。在这种情况下，需要逆转抗凝作用。有证据表明，idarucizumab是逆转达比加群诱导凝血病作用的首选药物。凝血酶原复合物浓缩物适用于逆转与华法林、利伐沙班和阿哌沙班相关的危及生命的出血。维生素K和新鲜冷冻血浆适用于逆转与华法林相关的凝血病。在与华法林相关的重度颅内出血病例中，凝血酶原复合物浓缩物优于维生素K和新鲜冷冻血浆。因子VII适用于存在抑制物的血友病患者，但尚未显示可降低死亡率。重要的是要认识到，这些逆转剂可能与血栓形成、过敏反应和容量超负荷等不良反应相关。

正确答案：A