抗凝固療法中に脳出血を合併した脳静脈血栓症に対しⅩa阻害薬投与が奏効した1例

Factor Ⅹa Inhibitor for the Treatment of Cerebral Venous Thrombosis with Intracerebral Hemorrhage during Anticoagulation Therapy:A Case Report

Ⅰ．はじめに

　脳静脈血栓症（cerebral venous thrombosis：CVT）は多彩な神経症状で発症する．しばしば進行性に増悪し，時に重篤となり治療に難渋することも少なくない¹¹⁾．しかし，症状の進行を認める脳静脈血栓症の予後改善には，閉塞脳静脈の早期再開通が求められ，迅速な対応が必要とされる．今回われわれは，未分画ヘパリン増量中に症状の増悪を認め，脳内出血を合併した脳静脈血栓症に対し，Ⅹa阻害薬であるアピキサバンの投与により，脳内出血の拡大を認めることなく閉塞脳静脈の早期再開通が得られ，良好な転帰を得た症例を経験したため，ここに報告する．

　A 46-year-old man presented with headache, right hemiparesis, and motor aphasia. A diagnosis of cerebral venous thrombosis with subarachnoid hemorrhage was made. We started intravenous administration of unfractionated heparin. After 6 days in hospital, the right hemiparesis and motor aphasia worsened, and brain computed tomographic（CT）images demonstrated intracerebral hemorrhage in the left parietal lobe. Therefore, we switched treatment from heparin to apixaban. His condition improved and a brain magnetic resonance（MR）venogram after 7 days in hospital showed recanalization of the cerebral veins. He was discharged with no apparent neurological defects 33 days after onset and his modified Rankin Scale score was 1. In cases of progressive cerebral venous thrombosis with intracerebral hemorrhage, during anticoagulation, it is necessary to achieve recanalization of the occluded cerebral vein rapidly without spreading the intracerebral hemorrhage. Factor Ⅹa inhibitors, especially apixaban, may be another option for treating cerebral venous thrombosis with intracerebral hemorrhage.