特定の逆転剤の時代における,非ビタミンK抗原口服抗凝固剤による出血の管理

Christian T Ruff¹, Robert P Giugliano², Elliott M Antman²

¹From TIMI Study Group, Cardiovascular Medicine Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. cruff@partners.org.

Circulation

|July 21, 2016

まとめ

新しい経口抗凝固薬 (NOACs) は,ワルファリンに代わるものですが,出血管理のための効果的な戦略が必要です. NOACに対抗するための特定の逆転剤が利用可能か,開発中である.

科学分野:

薬理学について
血液学
臨床医学

背景:

ビタミンKアンタゴニスト (VKA) は標準の抗凝固剤で,ビタミンKは逆転のために使用されます.
現在,4つの新しい非ビタミンK抗凝固剤 (NOAC) が利用可能である.
NOACはワルファリンと同様のまたは低い出血率ですが,出血を管理し,その効果を逆転させることが重要です.

研究の目的:

血液の管理とNOACの効果の逆転のための戦略をレビューする.
NOACの投与量調整と併用抗血栓剤の使用を避ける重要性を強調する.
NOAC の利用可能なおよび試験中の逆転剤について議論する.

主な方法:

NOAC管理に関する現在の臨床実践と文献のレビュー.
NOACの実験室でのモニタリングの検討
NOACの非特異性および特異性逆転剤の評価

主要な成果:

NOACの出血リスクを最小限に抑えるには,腎機能不全のために投与量を調整し,他の抗血栓剤を避ける必要があります.
NOACの抗凝固効果を測定するには,専門的な測定法が最適ですが,いくつかの標準的な検査は洞察力を提供します.
非特異剤 (PCCs,rFVIIa) と特異剤 (idarucizumab, andexanet alfa,ciraparantag) はNOACを逆転させることができる.

結論:

血液の管理とNOACの逆戻りには効果的な戦略が必要です.
イダルシズマブ,アンデキサネットアルファ,シラパランタグは特定の逆転剤として有望である.
最適なNOACの逆転には,さらなる研究と臨床経験が不可欠です.

キーワード:

抗凝固剤心房細動血流静脈血栓塞栓症

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