medicina60巻13号

2023年12月発行

特集 一般医家のための—DOAC時代の心房細動診療 心房細動の薬物治療と管理

4つのDOACをどう使い分ける？

著者： 鈴木信也¹

所属機関： ¹心臓血管研究所

ページ範囲：P.2268 - P.2273

Point
◎直接作用型経口抗凝固薬（DOAC）は4種類が使用可能で，それぞれに特徴的な薬物プロファイルがある．
◎DOACの使い分けは，主に腎機能（クレアチニン・クリアランス：CCr）と投与回数（1日1回か2回か）に注目するとよい．
◎腎機能（CCr）は，80 mL/分以上，50〜79 mL/分，30〜49 mL/分，30 mL/分未満にゾーン分けして，適したDOACを選ぶ．
◎投与回数（1日1回か2回か）の判断は，アドヒアランスを考慮して判断する．

参考文献

1）Ruff CT, et al：Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation；A meta-analysis of randomised trials. Lancet 383：955-962, 2014

2）Hori M, et al；Re-Ly Investigators：Dabigatran versus warfarin；Effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation. Stroke 44：1891-1896, 2013

3）Wong KSL, et al；Executive Steering Committee and the ROCKET AF Study Investigators：Rivaroxaban for stroke prevention in East Asian patients from the ROCKET AF trial. Stroke 45：1739-1747, 2014

4）Goto S, et al；ARISTOTLE Investigators：Efficacy and safety of apixaban compared with warfarin for stroke prevention in patients with atrial fibrillation from East Asia；A subanalysis of the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation（ARISTOTLE）Trial. Am Heart J 168：303-309, 2014

5）Yamashita T, et al：Edoxaban vs. warfarin in east Asian patients with atrial fibrillation；An ENGAGE AF-TIMI 48 Subanalysis. Circ J 80：860-869, 2016

6）Beyer-Westendorf J, et al：Drug persistence with rivaroxaban therapy in atrial fibrillation patients-results from the Dresden non-interventional oral anticoagulation registry. Europace 17：530-538, 2015

7）Okumura K, et al；J-ELD AF Investigators：A multicenter prospective cohort study to investigate the effectiveness and safety of apixaban in Japanese elderly atrial fibrillation patients（J-ELD AF Registry）. Clin Cardiol 43：251-259, 2020

8）Del-Carpio Munoz F, et al：Meta-analysis of renal function on the safety and efficacy of novel oral anticoagulants for atrial fibrillation. Am J Cardiol 117：69-75, 2016

9）Okumura K, et al；ELDERCARE-AF Committees and Investigators：Low-dose edoxaban in very elderly patients with atrial fibrillation. N Engl J Med 383：1735-1745, 2020

10）Suzuki S, et al：Predictors for a high apixaban level in elderly patients with atrial fibrillation prescribed reduced dose of apixaban. Eur J Clin Pharmacol 77：1757-1758, 2021

11）Vrijens B, Heidbuchel H：Non-vitamin K antagonist oral anticoagulants；Considerations on once- vs. twice-daily regimens and their potential impact on medication adherence. Europace 17：514-523, 2015