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雑誌文献

循環器ジャーナル68巻4号

2020年10月発行

文献概要

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

血栓溶解薬(モンテプラーゼ・ウロキナーゼ)の適応と使い方は?

著者: 山田典一1

所属機関: 1桑名市総合医療センター循環器内科

ページ範囲:P.658 - P.664

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・急性肺血栓塞栓症では循環動態が不安定な高リスク/広範型の症例に対し,モンテプラーゼの末梢静脈からの全身投与を行う.
・深部静脈血栓症では限定した適応症例に対してウロキナーゼを用いることがあるが,全身投与は推奨されずカテーテルにて血栓局所に投与する.
・血栓溶解療法を用いる場合には出血リスクを十分検討したうえで使用すべきである.

参考文献

1) Marti C, John G, Konstantinides S, et al:Systemic thrombolytic therapy for acute pulmonary embolism:a systematic review and meta-analysis. Eur Heart J 36:605-614, 2015
2) 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 54:543-603, 2020
3) Meyer G, Vicaut E, Danays T, et al:Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370:1402-1411, 2014
4) 日本循環器学会: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 http://www.j-circ.or.jp/cms/wp/content/uploads/2020/02/JCS2017_ito_h.pdf
5) 山田典一:深部静脈血栓症と肺血栓塞栓症:最近の動向と治療戦略.日本内科学会雑誌106:1875-1881, 2017
6) Sharma GV, Folland ED, McIntyre KM, et al:Long-term benefit of thrombolytic therapy in patients with pulmonary embolism. Vasc Med 5:91-95, 2000
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9) Kearon C, Akl EA, Ornelas J, et al:Antithrombotic Therapy for VTE Disease:CHEST Guideline and Expert Panel Report. Chest 149:315-352, 2016
Radiologic Management of Iliofemoral Venous Thrombosis. J Am Coll Radiol 17:S255-S264, 2020
11) Akhtar OS, Lakhter V, Zack CJ, et al:Contemporary Trends and Comparative Outcomes With Adjunctive Inferior Vena Cava Filter Placement in Patients Undergoing Catheter-Directed Thrombolysis for Deep Vein Thrombosis in the United States:Insights From the National Inpatient Sample. JACC Cardiovasc Interv 11:1390-1397, 2018
12) Enden T, Haig Y, Kløw NE, et al:Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis(the CaVenT study):a randomised controlled trial. Lancet 379:31-38, 2012
13) Haig Y, Enden T, Grøtta O, et al:Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis(CaVenT):5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol 3:e64-e71, 2016
14) Vedantham S, Goldhaber SZ, Julian JA, et al:Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 377:2240-2252, 2017
15) Comerota AJ, Kearon C, Gu CS, et al:Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation 139:1162-1173, 2019
16) Matsuda A, Yamada N, Ogihara Y, et al:Early and long-term outcomes of venous stent implantation for iliac venous stenosis after catheter-directed thrombolysis for acute deep vein thrombosis. Circ J 78:1234-1239, 2014
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18) Konstantinides SV, Torbicki A, Agnelli G, et al:2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 36:3033-3069, 2015

掲載誌情報

出版社:株式会社医学書院

電子版ISSN:2432-3292

印刷版ISSN:2432-3284

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