抗血栓治療と冠動脈疾患の進行. 抗血小板薬と抗血小板薬の比較について

J H Chesebro¹, M W Webster, P Zoldhelyi

¹Divisions of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Circulation

|December 1, 1992

まとめ

トロンビンは,動脈栓塞と冠動脈疾患の進行において重要な役割を果たします. 新型抗血栓剤は壁血栓症を予防する可能性があるが,慢性使用と疾患進行への影響についてはさらなる研究が必要である.

科学分野:

心血管医学心血管医学
血液学ヘマトロジ
薬理学薬理学とは

背景:

冠動脈疾患 (CAD) は数十年にわたって進行し,脂質の蓄積,プラークの破壊,および血栓形成を含む.
動脈血栓症,特に壁血栓形成は,CADにおける重要な出来事です.
トロンビンは,特に深血管損傷の後に,動脈血栓症の中心的な媒介体です.

研究の目的:

動脈血栓症におけるトロンビンの重要な役割を明らかにする.
CADの進行を防ぐための従来の抗血栓治療の限界について議論する.
CADにおける壁血栓症の予防と治療のための新しい抗血栓素の可能性を調査する.

主な方法:

動脈栓塞とCADにおけるトロンビンの役割に関する既存の文献のレビュー.
壁性血栓の予防における特異的な血栓抑制 (例えば,ヒルジン) の有効性の分析.
従来の抗血栓性療法 (アスピリンなど) と特定の血栓抑制剤の比較.

主要な成果:

特定のトロンビン阻害は,体内では,内壁血栓を完全に防ぐことができます.
深い動脈損傷による血小板に富んだトロンビは,著しく高いトロンビン阻害レベルを必要とします.
従来の抗血栓治療は臨床的イベントを軽減しますが,CADの進行を止めることはできません.

結論:

トロンビンは動脈血栓形成に不可欠であり,CADの進行を促します.
現在の抗血栓治療は,深層動脈損傷における壁血栓の予防には不十分である.
高出血リスクのない経口投与可能な慢性抗血栓剤の開発は,CADの進行を減らすために必要である.

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