ヘパリン誘発性血小板閉塞症患者のアルガトロバン抗凝固剤療法
B E Lewis1, D E Wallis, S D Berkowitz
1Loyola University Medical Center, Maywood, Illinois, USA. blewis@LUMC.edu
Circulation
|April 11, 2001
まとめ
アルガトロバンは,ヘパリン誘発性血小板閉塞症 (HIT) と,血小板症候群によるHIT (HITTS) を効果的に治療し,死亡や新たな血小板形成などの有害事象を軽減します. この直接的トロンビン阻害剤は,出血リスクを増加させることなく,改善された臨床結果を提供します.
科学分野:
- 心血管医学は,心臓血管医学である.
- 血液学 ヘマトロジ
- 薬理学 薬理学とは
背景:
- ヘパリン誘発性血小板減少症 (HIT) は,ヘパリン療法における免疫媒介による深刻な合併症である.
- HITは,血小板減少症や血栓形成症を含む深刻な結果につながる可能性があります.
- 直接的なトロンビン阻害剤であるアルガトロバンは,HITとHITとトロンボシス症候群 (HITTS) に対して評価されています.
研究 の 目的:
- HITまたはHITTSの患者における抗凝固剤としてのアグラトロバンの有効性と安全性を評価する.
- グラストロバン治療の臨床結果を,過去の対照被験者と比較するために.
主な方法:
- アガストロバンで治療されたHIT (n=160) またはHITTS (n=144) の患者を対象とした前向きな,歴史的にコントロールされた研究.
- アルガトロバンの投与量は,活性化された部分血栓形成時間 (aPTT) の1.5~3.0倍をベースラインに維持するために調整されました.
- 結果は37日間の193人の歴史的な対照被験者と比較されました.
主要な成果:
- アルガトロバンは,HIT患者における死亡,截肢,または新たな血栓形成の複合エンドポイントを有意に低下させた (25.6%対38.8%,P=0.014).
- タイム・トゥ・イベント分析は,HITとHITTSの両方で,複合エンドポイント (P=0.010とP=0.014,それぞれ) に対してアグラトロバンを好みました.
- アルガトロバン療法は,より迅速な治療的aPTT達成と,血小板数のより急速な上昇をもたらし,対照群と比較して同様の出血発生率をもたらしました.
結論:
- アルガトロバン抗凝固薬は,ヘパリン誘発性血小板閉塞症患者の臨床結果を改善します.
- アグラストロバンによる治療は,過去の対照群と比較して出血リスクを増加させない.
- アルガトロバンは,HITとHITTSの管理に有効な治療法です.
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