BRAIN and NERVE－神経研究の進歩73巻9号

2021年09月発行

特集 脳卒中治療に必要な基礎知識

抗血小板薬と抗凝固薬

著者： 北川一夫¹

所属機関： ¹東京女子医科大学脳神経内科

ページ範囲：P.975 - P.982

文献概要

脳梗塞では再発予防に抗血栓療法は必須である。心原性脳塞栓症では抗凝固薬，非心原性脳梗塞では抗血小板薬がガイドラインでも推奨され広く普及している。非弁膜症性心房細動を基盤とした心原性脳塞栓症では，出血リスク，特に脳出血リスクの少ない直接経口抗凝固薬が用いられている。一方で腎機能障害を有する心房細動患者，人工弁，心臓弁膜症，心筋症などからの塞栓症予防にはワルファリンが使用される。非心原性脳梗塞では，アスピリン，クロピドグレル，シロスタゾールの抗血小板薬が選択される。急性期は特に再発リスクが高く，抗血小板薬2剤，特にアスピリンとクロピドグレルの併用を行うことが推奨される。一方慢性期では脳出血リスクを回避するため原則として抗血小板薬単剤使用が勧められている。

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