循環器ジャーナル68巻4号

2020年10月発行

特集 抗血栓療法—日常臨床での疑問に応える Ⅲ．深部静脈血栓症・肺血栓塞栓症に対する抗血栓療法

深部静脈血栓症・肺血栓塞栓症に対する抗凝固療法の注意点は？—急性期治療と維持療法

著者： 山本剛¹ 山田健太¹

所属機関： ¹日本医科大学付属病院心臓血管集中治療科

ページ範囲：P.641 - P.649

Point
・初期および維持治療期における抗凝固療法では，適正の用法，用量を遵守する．
・延長治療では，定期的に再発リスクおよび出血リスクを評価し継続の是非を検討する．

参考文献

1) 日本循環器学会，他：肺血栓塞栓症および深部静脈血栓症の診断，治療，予防に関するガイドライン（2017年改訂版）2018　https://www.j-circ.or.jp/old/guideline/pdf/JCS2017_ito_h.pdf

2) 関　俊樹，山本　剛：ヘパリン，エノキサパリン，フォンダパリヌクスの適応と使用法．Medicina 56:272-275, 2019

3) 山本　剛：抗凝固薬．日本脈管学会（編）：臨床脈管学，pp149-150，日本医学出版，2017

4) 山本　剛，門岡浩介：経口抗凝固薬の適正使用—DOAC．日本血栓止血学会誌30:112-115, 2019

5) Nakamura M, Miyata T, Ozeki Y, et al:Current venous thromboembolism management and outcomes in Japan. Circ J 78:708-717, 2014

6) Mazzolai L, Aboyans V, Ageno W, et al:Diagnosis and management of acute deep vein thrombosis:a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. Eur Heart J 39:4208-4218, 2018

7) Konstantinides SV, Meyer G, Becattini C, et al:2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society（ERS）. Eur Heart J 41:543-603, 2020

8) Smith SB, Geske JB, Maguire JM, et al:Early anticoagulation is associated with reduced mortality for acute pulmonary embolism. Chest 137:1382-1390, 2010

9) Meyer G, Vicaut E, Danays T, et al:Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370:1402-1411, 2014

10) Barco S, Schmidtmann I, Ageno W, et al:Early discharge and home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban:an international multicentre single-arm clinical trial. Eur Heart J 41:509-518, 2020

11) Cheung YW, Middeldorp S, Prins MH, et al:Post-thrombotic syndrome in patients treated with rivaroxaban or enoxaparin/vitamin K antagonists for acute deep-vein thrombosis. A post-hoc analysis. Thromb Haemost 116:733-738, 2016

12) Kearon C, Akl EA, Ornelas J, et al:Antithrombotic Therapy for VTE Disease:CHEST Guideline and Expert Panel Report. Chest 149:315-352, 2016

13) Righini M, Galanaud JP, Guenneguez H, et al:Anticoagulant therapy for symptomatic calf deep vein thrombosis（CACTUS）:a randomised, double-blind, placebo-controlled trial. Lancet Haematol 3:e556-e562, 2016

14) Trujillo-Santos J, Lozano F, Lorente MA, et al:A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs. Am J Med 128:90.e9-e15, 2015

15) Yamashita Y, Morimoto T, Amano H, et al:Anticoagulation Therapy for Venous Thromboembolism in the Real World-From the COMMAND VTE Registry. Circ J 82:1262-1270, 2018

16) Wells PS, Forgie MA, Rodger MA:Treatment of venous thromboembolism. JAMA 311:717-728, 2014

17) Klok FA, Barco S, Konstantinides SV:External validation of the VTE-BLEED score for predicting major bleeding in stable anticoagulated patients with venous thromboembolism. Thromb Haemost 117:1164-1170, 2017

18) Nishimoto Y, Yamashita Y, Morimoto T, et al:Validation of the VTE-BLEED score's long-term performance for major bleeding in patients with venous thromboembolisms:From the COMMAND VTE registry. J Thromb Haemost 18:624-632, 2020