medicina46巻1号

2009年01月発行

今月の主題 循環器薬の使い方 2009 病態に応じた薬物治療の基本

PCI後の薬物療法

著者： 田辺健吾¹

所属機関： ¹三井記念病院循環器内科

ページ範囲：P.106 - P.108

ポイント

●アスピリン＋チエノピリジン（チクロピジンまたはクロピドグレル）の2剤抗血小板薬療法はPCI後，BMSの場合は1カ月，DESの場合12カ月が推奨される．

●DESの場合，抗血小板薬を完全に中止してしまうとステント血栓症を発症する可能性があり，注意を要する．

●抜歯や体表の小手術では，抗血小板薬は中止すべきではない．

参考文献

1）Tu JV, et al : Effectiveness and safety of drug-eluting stents in Ontario. N Engl J Med 357 : 1393-1402, 2007

2）Daemen J, et al : Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice : data from a large two-institutional cohort study. Lancet 369 : 667-678, 2007

3）Eisenstein EL, et al : Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 297 : 159-168, 2007

4）Grines CL, et al : Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents : a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation 115 : 813-818, 2007

5）Airoldi F, et al : Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment. Circulation 116 : 745-754, 2007

6）Bhatt DL, et al : Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting. J Am Coll Cardiol 39 : 9-14, 2002

7）Mehta SR, et al : Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention : the PCI-CURE study. Lancet 358：527-533, 2001

8）Fleisher LA, et al : ACC／AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery : Executive Summary : A Report of the American College of Cardiology／American Heart Association Task Force on Practice Guidelines（Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery）Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol 50 : 1707-1732, 2007

9）McFadden EP, et al : Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 364 : 1519-1521, 2004

10）循環器疾患における抗凝固・抗血小板療法に関するガイドライン．Circ J 68（Supp IV）：1153-1219, 2004