V．抗凝固療法の適応と実際
心房細動（atrial fibrillation：AF）患者の心原性脳塞栓症予防は変革の時を迎えている．Direct oral anticoagulant（DOAC）の登場により，抗凝固療法開始の敷居は低くなり，また，その安全性から，高齢AF患者への使用も増加している．それに伴い，抗凝固薬投与中の患者が予期せぬ手術を受ける機会も増えている．そこで，本稿では，AF患者における抗凝固療法の適応と実際の使用法，周術期管理から高齢者の抗凝固薬投与の適応等，自施設データやエビデンスを踏まえ，解説することとする．...
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| Published in | 日本内科学会雑誌 Vol. 108; no. 2; pp. 225 - 233 |
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| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本内科学会
10.02.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-5384 1883-2083 |
| DOI | 10.2169/naika.108.225 |
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| Abstract | 心房細動（atrial fibrillation：AF）患者の心原性脳塞栓症予防は変革の時を迎えている．Direct oral anticoagulant（DOAC）の登場により，抗凝固療法開始の敷居は低くなり，また，その安全性から，高齢AF患者への使用も増加している．それに伴い，抗凝固薬投与中の患者が予期せぬ手術を受ける機会も増えている．そこで，本稿では，AF患者における抗凝固療法の適応と実際の使用法，周術期管理から高齢者の抗凝固薬投与の適応等，自施設データやエビデンスを踏まえ，解説することとする． |
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| AbstractList | 心房細動（atrial fibrillation：AF）患者の心原性脳塞栓症予防は変革の時を迎えている．Direct oral anticoagulant（DOAC）の登場により，抗凝固療法開始の敷居は低くなり，また，その安全性から，高齢AF患者への使用も増加している．それに伴い，抗凝固薬投与中の患者が予期せぬ手術を受ける機会も増えている．そこで，本稿では，AF患者における抗凝固療法の適応と実際の使用法，周術期管理から高齢者の抗凝固薬投与の適応等，自施設データやエビデンスを踏まえ，解説することとする． |
| Author | 永嶋, 孝一 奥村, 恭男 |
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| Copyright | 2019 一般社団法人 日本内科学会 |
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| DOI | 10.2169/naika.108.225 |
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| References | 4) ARISTOTLE Committees and Investigators: Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365: 981-992, 2011. 2) RE-LY Steering Committee and Investigators: Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361: 1139-1151, 2009. 3) ROCKET AF Investigators: Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med 365: 883-891, 2011. 5) ENGAGE AF-TIMI 48 Investigators: Edoxaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med 369: 2093-2104, 2013. 7) Hart RG, et al: Prevention of stroke in patients with nonvalvular atrial fibrillation. Neurology 51: 674-681, 1998. 1) 日本循環器学会・他: 心房細動治療 (薬物) ガイドラン (2013年改訂版). 2014, 20-21. 8) Doherty JU, et al: 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation: A Report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol 69: 871-898, 2017. 9) Rechenmacher SJ, Fang JC: Bridging Anticoagulation: Primum Non Nocere. J Am Coll Cardiol 66: 1392-1403, 2015. 6) Okumura Y, et al: Three-Year Clinical Outcomes Associated With Warfarin vs. Direct Oral Anticoagulant Use Among Japanese Patients With Atrial Fibrillation - Findings From the SAKURA AF Registry. Circ J 82: 2500-2509, 2018. 10) Piccini JP, et al: Polypharmacy and the Efficacy and Safety of Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation. Circulation 133: 352-360, 2016. |
| References_xml | – reference: 9) Rechenmacher SJ, Fang JC: Bridging Anticoagulation: Primum Non Nocere. J Am Coll Cardiol 66: 1392-1403, 2015. – reference: 5) ENGAGE AF-TIMI 48 Investigators: Edoxaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med 369: 2093-2104, 2013. – reference: 10) Piccini JP, et al: Polypharmacy and the Efficacy and Safety of Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation. Circulation 133: 352-360, 2016. – reference: 1) 日本循環器学会・他: 心房細動治療 (薬物) ガイドラン (2013年改訂版). 2014, 20-21. – reference: 6) Okumura Y, et al: Three-Year Clinical Outcomes Associated With Warfarin vs. Direct Oral Anticoagulant Use Among Japanese Patients With Atrial Fibrillation - Findings From the SAKURA AF Registry. Circ J 82: 2500-2509, 2018. – reference: 2) RE-LY Steering Committee and Investigators: Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361: 1139-1151, 2009. – reference: 4) ARISTOTLE Committees and Investigators: Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365: 981-992, 2011. – reference: 3) ROCKET AF Investigators: Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med 365: 883-891, 2011. – reference: 7) Hart RG, et al: Prevention of stroke in patients with nonvalvular atrial fibrillation. Neurology 51: 674-681, 1998. – reference: 8) Doherty JU, et al: 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation: A Report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol 69: 871-898, 2017. |
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| Snippet | 心房細動（atrial fibrillation：AF）患者の心原性脳塞栓症予防は変革の時を迎えている．Direct oral anticoagulant（DOAC）の登場により，抗凝固療法開始の敷居は... |
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| Title | V．抗凝固療法の適応と実際 |
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