目的　评价不同时间窗降纤、抗凝治疗急性脑梗死的疗效及不良反应。方法　发病在24h内的急性脑梗死患者180例随机分为降纤组(A组)、抗凝组(B组)和对照组(C组);分别给予降纤酶(第1天10U和第3、5天各5U)、低分子量肝素(4 100U腹壁皮下注射, 1日两次,连用10d)、低分子右旋糖酐500ml加丹参24g静脉滴注,每日1次, 10d为1疗程治疗。结果　发病时间≤6h者,欧洲中风神经功能量表评分抗凝组比降纤组高(P<0. 05); 6h后至24h,抗凝组均比降纤组低(P<0. 05);日常生活能力评分无明显差异(P>0. 05),且均无不良反应。结论　发病时间≤6h应用抗凝治疗急性脑梗死效果较好,而在6h后至24h,则降纤效果显著。 Objective To evaluate the efficacy and adverse reactions of anti-coagulation therapy for acute cerebral infarction at different time windows. Methods A total of 180 patients with acute cerebral infarction within 24 hours were randomly divided into three groups: A group, anticoagulation group and C group; 3, 5 days each 5U), low molecular weight heparin (4 100U abdominal subcutaneous injection twice a day, once every 10d), low molecular weight dextran 500ml plus Salvia 24g intravenous infusion, once daily, 10d for a course of treatment. Results When the onset time was less than 6h, the score of European Stroke Nervous Function Scale in anticoagulant group was significantly higher than that of fibrosis group (P <0.05); after 6h to 24h, anticoagulation group was lower than that of fibrosis group (P <0.05) ); There was no significant difference in daily living ability score (P> 0.05), and no adverse reactions. Conclusion The onset time of ≤ 6h anticoagulant treatment of acute cerebral infarction better, and in 6h to 24h, then the effect of fibrinolytic significant.