medicina49巻6号

2012年06月発行

今月の主題 新規経口抗凝固薬の光と影 新規経口抗凝固薬とワルファリンの類似点と相違点

心房細動と脳卒中予防におけるワルファリンの使用実態

著者： 戸田恵理¹ 後藤信哉²

所属機関： ¹東海大学八王子病院内科学系（循環器内科領域） ²東海大学付属病院内科学系（循環器内科領域）

ページ範囲：P.1019 - P.1021

ポイント

★本邦での心房細動患者数は増加傾向にある．

★ワルファリンの脳卒中予防効果は実証されているが，使用するにあたり，世界と本邦では至適INR，血栓症発生率が異なっている可能性を考慮する必要がある．

参考文献

1）Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT（European Atrial Fibrillation Trial）Study Group. Lancet 342：1255-1262, 1993

2）Koudstaal PJ：Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks. Cochrane Database Syst Rev, 1995

3）Koudstaal PJ：Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks. Cochrane Database Syst Rev 1996（1）

4）Hart RG, et al：Antithrombotic therapy to prevent stroke in patients with atrial fibrillation：a meta-analysis. Ann Intern Med 131：492-501, 1999

5）後藤信哉，浅田祐士郎：血栓症―優しく，詳しく，分かりやすく―．南江堂，2004

6）Klein KL, et al：Equal effectiveness of very-low-intensity anticoagulation and standard low-intensity anticoagulation：a pilot study. South Med J 88：1136-1139, 1995

7）Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation：Stroke Prevention in Atrial Fibrillation Ⅲ randomised clinical trial. Lancet 348：633-638, 1996

8）Hylek EM, et al：An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med 335：540-546, 1996

9）Yamaguchi T：Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation：a multicenter, prospective, randomized trial. Japanese Nonvalvular Atrial Fibrillation-Embolism Secondary Prevention Cooperative Study Group. Stroke 31：817-821, 2000

10）Yasaka M, et al：Optimal intensity of international normalized ratio in warfarin therapy for secondary prevention of stroke in patients with non-valvular atrial fibrillation. Intern Med 40：1183-1188, 2001

11）Goto S, et al：Prevalence, clinical profile and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Am Heart J 156：855-863, 863 e2, 2008

12）Goto S, et al for the J-TRACE Investigators. One-year cardiovascular event rate in Japanese outpatients with myocardial infarction, stroke, and atrial fibrillation-results from the Japan Thrombosis Registry for Atrial Fibrillation（J-TRACE）-. Circulation Journal 75（11）：2598-2604, 2011