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 Ⅳ．脳卒中に対する抗血栓療法

心原性脳塞栓症に対する抗血栓療法—急性期治療と二次予防はどうするか？

著者： 本田有子¹ 平野照之¹

所属機関： ¹杏林大学医学部脳卒中医学教室

ページ範囲：P.672 - P.679

Point
・心原性脳塞栓症は脳梗塞の27.7%を占め，年々その割合は上昇している．心原性脳塞栓症は粗大な血栓の飛散により重症度が高く，転帰も不良な傾向がある．
・脳主幹動脈閉塞は治療開始まで一刻を争う場合が多く，治療法として機械的血栓回収療法が主流となった．血栓溶解療法としてアルテプラーゼが主体であるが，効果の側面から今後tenecteplaseの導入が待たれている．
・頭蓋内出血の発症率の高い日本人にとって，心房細動による心原性脳梗塞発症予防に対するDOACは，ワルファリンよりも安全性・有効性に優れた薬剤であることが示されている．

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