BRAIN and NERVE－神経研究の進歩65巻7号

2013年07月発行

増大特集 あしたの脳梗塞

抗血小板療法―再発予防update

著者： 内山真一郎¹

所属機関： ¹東京女子医科大学医学部神経内科学講座

ページ範囲：P.771 - P.782

文献概要

はじめに

　非心原性脳梗塞の再発予防には，脳動脈を閉塞させる血小板血栓の形成を阻害する抗血小板療法の適応がある¹⁾。しかしながら，抗血小板療法による脳卒中予防効果には限界があり，現状では脳卒中を20～30％減少させる程度であることから，作用機序の異なる複数の抗血小板薬の併用療法（dual antiplatelet therapy：DAPT）が行われるようになった。また，抗血小板薬の効果の限界には薬剤抵抗性が関与しているとの考えから，抵抗性（resistance）の少ない薬剤の開発が求められている。血小板が主役を演じる生理的止血機構と病的血栓形成機構は多くの部分が重なり合うので，抗血小板薬の宿命的な副作用として出血性合併症が問題となるが，血小板活性化機構を選択的に阻害し，生理的止血機構に影響を及ぼしにくい分子標的薬の開発も行われている。日常診療においては，エビデンスに基づいてリスクベネフィットを勘案しながら個々の症例に応じて薬剤が選択されているのが現状である。

　本稿では，脳梗塞再発予防における，これらのトピックに関して最新の情報をエビデンスに基づき概説する。

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