脳梗塞急性期治療におけるエダラボン・オザグレル併用療法の有用性

The Clinical Effect of Combination Therapy with Edaravone and Sodium Ozagrel for Acute Cerebral Infarction

要旨　脳梗塞治療薬として新たに登場した脳保護薬エダラボンは，従来の抗血栓作用を主とした薬剤とは作用機序が異なるため，単独あるいは他剤との併用による効果が期待される。われわれは2001年6月1日から2002年3月末日までの10カ月間に入院加療した発症後24時間以内の急性期脳梗塞患者にエダラボンとオザグレルナトリウム（オザグレル）を併用し，従来のオザグレル単独の治療成績と比較した。エダラボン併用群62例のうち，ラクナ梗塞は32例（52％），アテローム血栓性脳梗塞は19例（31％）であった。退院時のmodified Rankin Scale（MRS）では，脳梗塞全体，およびアテローム血栓性脳梗塞において，エダラボン併用群においてMRS 0から1の自立例がオザグレル単独群に対して統計学的に有意に増加した。MRSの改善度（入院時と退院時のMRSの差）では，脳梗塞全体，およびアテローム血栓性脳梗塞において統計学的に有意な改善が認められた。ラクナ梗塞では差を認めなかった。以上から，エダラボンは発症後24時間以内の急性期の脳梗塞，とくにアテローム血栓性脳梗塞に有用であった。

Sodium ozagrel （ozagrel）, a selective thromboxane A2 synthetase inhibitor, has been used for the treatment of various types of acute ischemic stroke, except cardioembolic stroke. Recently, edaravone, a novel free radical scavenger, has been approved for the treatment of acute ischemic stroke within 24 hours after onset. Since these two drugs differ in mode of action, we hypothesized that combination of both drugs would yield further improvement of the outcome of patients with acute ischemic stroke. The clinical efficacy of combination therapy with edaravone and ozagrel for acute ischemic stroke was studied retrospectively, and compared with that of ozagrel alone. A total of 62 patients who suffered acute ischemic stroke within 24 hours after onset during the 10-month period from June 2001 to March 2002, were treated with both edaravone and ozagrel （E-O group）, while 76 patients during August 2000 to May 2001, were treated with ozagrel alone （O group）. The rate of modified Rankin Scale（MRS）0 and 1 at discharge in the total ischemic stroke and atherothrombotic stroke, was significantly higher in the E-O group than in the O group. The improvement in MRS also differed between E-O group and O group in total. The difference was significant in patients with atherothrombotic stroke but not in those with lacunar stroke. These results indicate that combination therapy with edaravone and ozagrel is more effective than mono-therapy with ozagrel for the treatment of acute ischemic, especially of atherothrombotic stroke.