(急)心瓣有事 血塊出現, 懷疑中風, 阿士匹靈還是薄血丸?

現在的問題是係信哪一個醫生。私家醫生說ASPIRIN OK，公立的說唔得，你信邊個？你信私家定公立？
老實說，我是不會給予任何意見的，因為你沒有理由會因為我的意見而不信一個心臟科醫生的意見的，不過我替你找過BMJ (BRITISH MEDICAL JOURNAL)的臨床證據(係一個權威的JOURNAL)。我引它們的結論︰
Systemic anticoagulants compared with aspirin Systemic anticoagulants (unfractionated and low molecular weight heparin) and aspirin given within 48 hours of ischaemic stroke are equally effective at 3–6 months at reducing death or dependency (high-quality evidence). Systemic anticoagulants are associated with an increased risk of intracranial haemorrhage.
http://clinicalevidence.bmj.com.eproxy3.lib.hku.hk/ceweb/conditions/cvd/0201/0201_I3_HARMS.jsp
Anticoagulant in people with sinus rhythm :Likely to be ineffective or harmful
http://clinicalevidence.bmj.com.eproxy3.lib.hku.hk/ceweb/conditions/cvd/0207/0207.jsp
Death or dependency:
The first two reviews found no significant difference in death or dependency after 3–6 months between anticoagulants and control (placebo or no treatment) or anticoagulants and aspirin. The other two reviews, which found the same five RCTs, provided insufficient evidence to compare anticoagulants versus each other for this outcome. The subsequent RCT found no significant difference between low molecular weight heparin and aspirin in a combined outcome defined as survival with a Barthel index score of 85 or higher at 6 months ( see table 2). [25]

2009-06-11 23:54:36 補充：
The second review found that anticoagulants (unfractionated and low molecular weight heparin) significantly increased symptomatic intracranial haemorrhage compared with aspirin.

2009-06-11 23:54:55 補充：
Analysis of this adverse effect by dose found a significantly higher rate of symptomatic intracranial haemorrhage with high-dose anticoagulants compared with aspirin. However, there was no significant difference between low doses of anticoagulants and aspirin.

2009-06-11 23:55:31 補充：
One subsequent RCT found a significantly higher rate of haemorrhagic adverse effects with low molecular weight heparin compared with aspirin. However, there was no significant difference between groups in reported adverse effects

2009-06-11 23:55:41 補充：
(type and severity not specified) at 6 months' follow-up (87/180 [48.3%] with low molecular weight heparin v 83/173 [47.9%] with aspirin; P = 0.95).
http://clinicalevidence.bmj.com.eproxy3.lib.hku.hk/ceweb/conditions/cvd/0201/0201_I3_BENEFITS.jsp

2009-06-11 23:56:03 補充：
綜合它們的意見，係薄血藥(ANTICOAGULANT)同阿士匹靈對預防中風的作用一樣，但引致腦出血的風險會增加。
不過，研究始終係研究，有好多野我都沒有考究，例如劑量的方面︰到底食幾多薄血藥會有這些副作用？或者係病人(實驗的病人)的方面︰他們同你親人的情況是否一樣？
我可以做的就係咁多，信邊個你自己想想LA。
PS: D LINK你可能入唔到，因為要登入的。

2009-06-11 23:56:40 補充：
SORRY，因為字數有限制，所以不斷ADD野