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BRAIN and NERVE Volume 70, Issue 5 （May 2018）

BRAIN and NERVE 70巻5号（2018年5月発行）

Japanese English

原著

急性期脳梗塞患者に対するアルガトロバン併用抗血小板薬2剤併用療法の安全性 Safety of Dual Antiplatelet Therapy with Argatroban in Patients with Acute Ischemic Stroke 永金義成 ¹ , 田中瑛次郎 ¹ , 芦田真士 ¹ , 小島雄太 ¹ , 小椋史織 ¹ , 前園恵子 ¹ , 山本康正 ^1,2 Yoshinari Nagakane ¹ , Eijirou Tanaka ¹ , Shinji Ashida ¹ , Yuta Kojima ¹ , Shiori Ogura ¹ , Keiko Maezono ¹ , Yasumasa Yamamoto ^1,2 ¹京都第二赤十字病院脳神経内科 ²京都桂病院脳神経内科 ¹Department of Neurology, Kyoto Second Red Cross Hospital ²Department of Neurology, Kyoto Katsura Hospital キーワード：脳梗塞 , 分枝アテローム血栓症 , アテローム血栓性梗塞 , 抗血小板薬2剤併用療法 , 抗凝固療法 , brain infarction , branch atheromatous disease , atherothrombotic infarction , dual antiplatelet therapy , anticoagulant therapy Keyword: 脳梗塞 , 分枝アテローム血栓症 , アテローム血栓性梗塞 , 抗血小板薬2剤併用療法 , 抗凝固療法 , brain infarction , branch atheromatous disease , atherothrombotic infarction , dual antiplatelet therapy , anticoagulant therapy pp.557-562

発行日 2018年5月1日 Published Date 2018/5/1

DOI https://doi.org/10.11477/mf.1416201038

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Abstract 文献概要
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参考文献 Reference

急性期増悪・再発リスクが高い虚血性脳卒中に対して，抗血小板薬2剤併用療法（DAPT）などのより積極的な抗血栓療法が行われているが，一方では出血リスクが増加する。本研究では，ハイリスク例に対してアルガトロバン併用DAPTを行った急性期虚血性脳卒中341例を対象に，退院または入院30日目までの出血性合併症を調査した。症候性頭蓋内出血は認められず，重篤な出血性合併症は1例（0.3％）に認められるのみであった。

Abstract

To prevent early neurological worsening or recurrence in stroke patients with intracranial arterial stenosis or branch atheromatous disease, aggressive antithrombotic therapy, such as dual antiplatelet therapy (DAPT) with or without anticoagulant therapy, is warranted. Such an aggressive antithrombotic therapy, however, may increase the bleeding risk. We studied the risks of DAPT with the anticoagulant argatroban in patients with acute ischemic stroke or transient ischemic attack (TIA). Between October 2011 and September 2015, 341 patients with stroke or TIA, who received DAPT with argatroban within 48 hours after onset, were retrospectively studied. The endpoint was any bleeding event during hospitalization or 30 days after admission. Median duration of DAPT was 12 days, and 66% of the patients received intravenous heparin (median duration, 5 days) following argatroban. No symptomatic intracerebral hemorrhages were observed, while severe, moderate, and mild extracranial hemorrhages occured in one (0.3%), three (0.9%), and four (1.2%) patients, respectively. In conclusion, DAPT with argatroban can be safely administered to patients with acute ischemic stroke or TIA.

(Received July 24, 2017; Accepted January 15, 2018; Published May 1, 2018)