2019年 · 第52卷第08期

The development history of neuromuscular disease group of Neurology Branch of Chinese Medical Association is also the development history of neuromuscular disease diagnosis and treatment, scientific research and academic exchange in China. This year marks the 70th anniversary of the founding of the People's Republic of China. We review the development history of the Neuromusculology Group of the Neurology Branch of the Chinese Medical Association in order to understand the work of our predecessors, and also to make us "keep our original intention in mind and keep our mission in mind", encourage us to redouble our efforts to move forward, and make greater achievements for the diagnosis, treatment and research of neuromuscular diseases in China.

"Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China 2018" published by your journal in September 2018^[1]In this article, the contraindications for intravenous thrombolysis of recombinant tissue plasminogen activator (rt-PA) within 3 h in Table 2 are "oral anticoagulant with international standardized ratio (INR)>1.7 or prothrombin time (PT)>15 s", which is consistent with the "Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2014"^[2]Consistent. However, the contraindication of rt-PA thrombolysis within 5 h in the "Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2010" is only stated as "oral anticoagulants have been taken, and INR>1.5"^[3]。 From 2010 to 2018, is this change due to the guidelines for early diagnosis and treatment of acute ischemic cerebral infarction published by the American Heart Association/American Stroke Association in 2013^[4]？ The guidelines listed INR>1.7 or PT>15 s as contraindications for rt-PA in patients with acute cerebral infarction who have been using anticoagulants, but did not specify which anticoagulant or class. The American Heart Association/American Stroke Association's scientific statement on the inclusion and exclusion criteria of intravenous rt-PA in acute ischemic stroke discusses the effects of warfarin, low-molecular-weight heparin (LMWH), and new oral anticoagulants (NOACs), namely direct thrombin inhibitors and Ⅹa inhibitors, on the use of rt-PA, respectively. It is clearly pointed out that the contraindications of intravenous rt-PA in anticoagulant users are: warfarin has been taken orally and INR>1.7; Have received LMWH treatment within 24 h; For those taking NOACs, the basis for treatment with rt-PA has not been established and may be harmful; Unless laboratory tests of activated partial thromboplastin time (APTT), INR, platelet count, viper venom coagulation time, PT, or direct factor Ⅹa activity measurements are within the normal range, or assuming that the patient has normal renal metabolism and has not taken NOACs for>48 h^[5]。 However, the European Stroke Medicine Textbook compiled for medical graduates only lists INR>1.4 as a contraindication for rt-PA intravenous thrombolysis^[6]。