新規抗凝固薬普及直前の時期における抗血栓療法下脳内出血の臨床的検討

Clinical Features of Intracerebral Hemorrhage under Antithrombotic Therapy in the Warfarin Era

Ⅰ．はじめに

　抗凝固療法および抗血小板療法が脳出血の患者の転帰に与えた影響について自験例を対象に検討した．2004年に刈部らが同様の方法で抗血栓療法下における脳出血について報告しているが¹⁰⁾，その後の約10年間で，抗血栓療法を支持する研究結果が多く現れ，社会の高齢化とも相まって抗血栓療法を受ける患者数が増加し，現在は新規抗凝固薬も普及しつつある．本研究の目的は，新規抗凝固薬導入直前の時期に，従来の抗血栓療法の普及が脳内出血にどのような影響を与えたか調べることである．

　We investigated the clinical characteristics and prognosis of intracerebral hemorrhage（ICH）under antithrombotic therapy. We retrospectively reviewed the medical records of 463 patients admitted to our hospital due to ICH during 3-year periiod between January 2010 and December 2012. The ICH patients were classified into 4 groups：patients with anticoagulant therapy（AC, n＝36), antiplatelet therapy（AP, n＝65), anticoagulant and antiplatelet therapies（AC＋AP, n＝18), and no antiplatelet or anticoagulant therapy（NT, n＝344).

　There were no significant differences between the groups in terms of gender, hematoma location, and initial hematoma size. Age and previous history of ischemic cerebral disease or ischemic coronary disease were significantly higher in the AC, AP, and AC＋AP groups than in the NT group. The number of patients who had received previous treatment for hypertension was higher in the AC, AP, and AC＋AP groups, and systolic blood pressure at admission was lower in the AC and AC＋AP groups than in the NT group. Hematoma enlargement occurred more frequently in the AC and AC＋AP groups. The AC, AP and AC＋AP groups showed worse prognosis and higher mortality than the NT group.

　Anticoagulant therapy can be a risk factor for hematoma enlargement, and anticoagulant and/or antiplatelet therapy can be a risk factor of poor outcome.