Neurological Surgery 脳神経外科43巻3号

2015年03月発行

研究

新規抗凝固薬普及直前の時期における抗血栓療法下脳内出血の臨床的検討

著者： 小濱みさき¹ 吉田昌弘¹ 三野正樹¹ 冨永悌二²

所属機関： ¹大崎市民病院脳神経外科 ²東北大学大学院医学系研究科神経外科学分野

ページ範囲：P.199 - P.205

Ⅰ．はじめに
　抗凝固療法および抗血小板療法が脳出血の患者の転帰に与えた影響について自験例を対象に検討した．2004年に刈部らが同様の方法で抗血栓療法下における脳出血について報告しているが¹⁰⁾，その後の約10年間で，抗血栓療法を支持する研究結果が多く現れ，社会の高齢化とも相まって抗血栓療法を受ける患者数が増加し，現在は新規抗凝固薬も普及しつつある．本研究の目的は，新規抗凝固薬導入直前の時期に，従来の抗血栓療法の普及が脳内出血にどのような影響を与えたか調べることである．

参考文献

1) Campbell PG, Yadla S, Sen AN, Jallo J, Jabbour P：Emergency reversal of clopidgrel in the setting of spontaneous intracerebral hemorrhage. World Neurosurg 76：100-104；discussions 59-60, 2011

2) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L；RE-LY Steering Committee and Investigators：Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361：1139-1151, 2009

3) Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P；CHANT Investigators：Hematoma growth in oral anticoagulant related intracerebral hemorrhage. Stroke 39：2993-2996, 2008

4) Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ；MATCH investigators：Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients（MATCH）:randomized, double-blind, placebo-controlled trial. Lancet 364：331-337, 2004

5) Fang MC, Chang Y, Hylek EM, Rosand J, Greenberg SM, Go AS, Singer DE：Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 141：745-752, 2004

6) Flaherty ML, Tao H, Haverbusch M, Sekar P, Kleindorfer D, Kissela B, Khatri P, Stettler B, Adeoye O, Moomaw CJ, Broderick JP, Woo D：Warfarin use leads to larger intracerebral hematomas. Neurology 71：1084-1089, 2008

7) Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ：Validation of clinical classification schemes for predicting stroke：results from the National Registry of Atrial Fibrillation. JAMA 285：2864-2870, 2001

8) Hart RG, Tonarelli SB, Pearce LA：Avoiding central nervous system bleeding during antithrombotic therapy. Stroke 36：1588-1593, 2005

9) Huttner HB, Schellinger PD, Hartmann M, Köhrmann M, Juettler E, Wikner J, Mueller S, Meyding-Lamade U, Strobl R, Mansmann U, Schwab S, Steiner T：Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy：comparison of acute treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex concentrates. Stroke 37：1465-1470, 2006

10) 刈部　博，清水宏明，社本　博，高橋敏行，冨永悌二：抗凝固療法・抗血小板療法下における脳出血の検討　脳卒中の外科32：398-402, 2004

11) Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J：The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27：1304-1305, 1996

12) Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM；ROCKET AF Investigators：Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365：883-891, 2011

13) Roitberg B, Emechebe-Kennedy O, Amin-Hanjani S, Mucksavage J, Tesoro E：Human recombinant factor VII for emergency reversal of coagulopathy in neusurgical patients：a retrospective comparative study. Neurosurgery 57：832-836；discussion 832-836, 2005

14) Sansing LH, Messe SR, Cucchiara BL, Cohen SN, Lyden PD, Kasner SE；CHANT Investigators：Prior antiplatelet use does not affect hemorrhage growth or outcome after ICH. Neurology 72：1397-1402, 2009

15) Shinohara Y, Katayama Y, Uchiyama S, Yamaguchi T, Handa S, Matsuoka K, Ohashi Y, Tanahashi N, Yamamoto H, Genka C, Kitagawa Y, Kusuoka H, Nishimaru K, Tsushima M, Koretsune Y, Sawada T, Hamada C；CSPS 2 group：Cilostazol for prevention of secondary stroke（CSPS 2）:an aspirin-controlled, double-blind, randomized non-inferiority trial. Lancet Neurol 9：959-968, 2010

16) Staessen JA, Wang JG, Thijs L：Cardiovascular protection and blood pressure reduction：a meta-analysis. Lancet 358：1305-1315, 2001

17) Toyoda K, Okada Y, Minematsu K, Kamouchi M, Fujimoto S, Ibayashi S, Inoue T：Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage. Neurology 65：1000-1004, 2005

18) Wang Y, Johnston SC；CHANCE Investigators：Rationale and design of a randomized, double-blind trial comparing the effects of a 3-month clopidogrel-aspirin regimen versus aspirin alone for the treatment of high-risk patients with acute nondisabling cerebrovascular event. Am Heart J 160：380-386, 2010