低用量アスピリンと冠動脈血管拡張剤の比較は,急性不安定性アンギナにおける比較
M Vejar1, D Hackett, C Brunelli
1Cardiovascular Research Unit Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Circulation
|January 1, 1990
まとめ
アスピリン単独の投与は,不安定な胸痛患者の血管拡張剤に優れているとは証明されませんでした. 初期治療が心筋不全や心臓発作を予防できない場合,早期冠動脈血管撮影を含む積極的な治療が必要となる患者もいます.
科学分野:
- 心臓病学 心臓病学
- 薬理学 薬理学とは
背景:
- 不安定性アンギナは,エピソード的な血小板活性化によって特徴付けられます.
- アスピリンは,不安定な胸痛の管理のための重要な治療薬です.
研究 の 目的:
- 41人の不安定な胸痛患者で,アスピリン単独の効果と血管拡張剤 (ヘパリン,ベータブロッカー) と併用したアスピリンの効果を評価する.
- 初期治療が再発性心筋不全症を予防できるかどうかを判断する.
主な方法:
- 患者はランダムに2つのグループに分けられた:グループ1は血管拡張剤 (イソソルビド・ディニートレート,ディルチアゼム),グループ2はアスピリンを受けた.
- 治療法 (アスピリン,血管拡張剤,ヘパリン,ベータブロッカー) は,心筋不全が再発した場合に順番に追加されました.
- アスピリンの有効性を評価するために血清トロンボキサンB2レベルを測定しました.
主要な成果:
- アスピリンは血清トロンボキサンB2を検出できないレベルまで大幅に低下させた.
- アスピリンだけでは,冠動脈拡張剤に優れず,不血症エピソードを予防しました.
- 30%の患者は,ヘパリンとβ阻害剤を服用したにもかかわらず,不血症や心筋梗塞を継続した.
- 異なる治療群で3人の患者に心筋梗塞が起こりました.
結論:
- 冠動脈栓塞と血管収縮の刺激は強力であり,時には標準的な抗薬剤を圧倒する可能性があります.
- 早期の冠動脈血管造影と積極的な治療は,併用療法に迅速に反応しない患者に推奨されます.
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