Neurological Surgery 脳神経外科48巻11号

2020年11月発行

総説

脳神経外科領域での抗血小板薬，抗凝固薬の使い方

著者： 末廣栄一¹ 田中達也¹ 道脇悠平¹ 若宮富浩¹ 田部井勇介¹ 河島雅到¹

所属機関： ¹国際医療福祉大学医学部脳神経外科

ページ範囲：P.989 - P.1003

Ⅰ．はじめに
　日本における65歳以上の高齢者人口は，2018年10月1日現在で3558万人となり，総人口に占める割合（高齢化率）は28.1%となった⁴⁷⁾．日本では急速に高齢化が進行しており，高齢者における心房細動の有病率の増加，心筋梗塞や脳梗塞などの動脈硬化性疾患の増加により，抗血栓薬の服用患者が激増している．抗血栓薬の服用は心筋梗塞や脳梗塞などの予防に効果的であるが，同時に頭蓋内出血を代表とする出血性合併症の発症を増加させるため，医療者は適切な抗血栓療法を心がけなければならない．しかし，近年の脳卒中診療の発展に伴い，数種類の直接型経口抗凝固薬（direct oral anticoagulant：DOAC）や抗血小板薬2剤併用療法（dual antiplatelet therapy：DAPT）などオプション治療の選択肢が拡がり，抗血栓薬の選択や投与のタイミングに悩むことも少なくない．
　本稿では，抗血小板薬，抗凝固薬の効果と安全性についてエビデンスを中心に再整理し，適切な抗血栓療法を選択できるよう導きたい．さらに，頭蓋内出血など出血性合併症を生じた場合には，症状を最小限に抑える必要があり，抗血栓薬に対する中和療法を含む適切な対応法についても解説する．

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