medicina56巻2号

2019年02月発行

特集 抗血栓療法のジレンマ—予防すべきは血栓か，出血か？ この疾患にはこの抗血栓薬が必要

心内腫瘍・血栓，人工弁・ステント留置後

著者： 齋藤佑一¹ 小林欣夫¹

所属機関： ¹千葉大学大学院医学研究院循環器内科学

ページ範囲：P.232 - P.236

Point
◎心内腫瘍に対しては手術治療が基本であり，抗血栓療法の介入余地は限定的である．
◎心内血栓には抗凝固療法を行う（ワルファリンのほかに，心房細動ではDOACも可）．
◎機械弁置換術後では終生ワルファリン投与を行うが，生体弁では術後早期に限る．
◎冠動脈ステント留置後は3〜6カ月のDAPTが基本だが，個々に検討する．

参考文献

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3）Saito Y, et al：ANCA-negative eosinophilic granulomatosis with polyangitis（EGPA）manifesting as a large intracardiac thrombus and glomerulonephritis with angionecrosis. BMJ Case Rep, 2016（doi：10.1136/bcr-2016-216520）

4）McCarthy CP, et al：Left ventricular thrombus after acute myocardial infarction；Screening, prevention, and treatment. JAMA Cardiol 3：642-649, 2018

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7）Baumgartner H, et al：2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 38：2739-2791, 2017

8）Valgimigli M, et al：2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS；The task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology（ESC）and of the European Association for Cardio-Thoracic Surgery（EACTS）. Eur Heart J 39：213-260, 2018

9）Vranckx P, et al：Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent；A multicentre, open-label, randomised superiority trial. Lancet 392：940-949, 2018

10）Angiolillo DJ, et al：Antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention；A north american perspective-2018 update. Circulation 138：527-536, 2018