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

DOACは用量が少ないほうが安全？—「脱under-dose」のススメ

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.2274 - P.2279

Point
◎クレアチニンクリアランス（CCr）30 mL/分以上の患者において，直接作用型経口抗凝固薬（DOAC）投与下の心房細動患者の90％では，添付文書通りの用量の投与により適切な血中濃度が得られ，脳卒中および大出血に対して良好なアウトカムが期待できる．
◎メタ解析によれば，DOACのunder-doseは脳梗塞を増加させる一方で大出血を減少させない．
◎CCr 30 mL/分未満の患者においては出血リスクを最大限回避し，慎重なモニタリングを行いながらDOACを投与する．
◎特にCCr 26 mL/分未満はアピキサバン減量投与でも出血リスクが高く，エドキサバン15 mgが適切な用量と考えられる．

参考文献

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