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？ 高い出血リスクに対する対策

抗血栓療法における海外と日本のリスクスコア

著者： 夏秋政浩¹

所属機関： ¹佐賀大学医学部循環器内科

ページ範囲：P.288 - P.293

Point
◎高出血リスク患者では，抗血小板薬2剤併用療法（DAPT）を3カ月の短期とすることがESCガイドラインで推奨されている．
◎CREDO-Kyotoリスクスコアは日本人のデータを基に作成されたリスクスコアであり，PCI施行患者の塞栓・出血リスク層別化が可能である．
◎ESCガイドラインでは抗凝固療法中の塞栓リスク評価にCHA₂DS₂-VAScスコア，出血リスク評価にHAS-BLEDスコアの使用が推奨されているが，日本人のデータを基にしたリスクスコアの作成が望まれる．
◎リスクスコアを参考に，個々の患者リスクに応じた抗血栓薬の投与期間決定が予後改善に重要である．

参考文献

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-VASc and HAS-BLED scores in Japanese patients with nonvalvular atrial fibrillation；An analysis of the J-RHYTHM Registry. Circ J 78：1593-1599, 2014