心房細動を持つ非常に高齢の患者における口腔抗凝固薬:全国的なコホート研究

Tze-Fan Chao^1,2, Chia-Jen Liu^3,4, Yenn-Jiang Lin^1,2

¹Division of Cardiology (T.-F.C., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-C.T., J.-N.L., F.-P.C., S.-A.C.).

Circulation

|March 2, 2018

まとめ

口服抗凝固剤 (OAC) は90歳以上の心房細動患者で脳卒中リスクを軽減します. ウォルファリンは好ましい効果を示したが,NOACは,この高齢者群で頭蓋内出血のリスクを低下させた.

科学分野:

心臓病科
高齢者医療
薬理学について

背景:

心房細動 (AF) の管理は,脳卒中予防のために口服抗凝固剤 (OAC) に依存しています.
90歳以上の患者でのOAC使用とアウトカムに関するデータは限られている.

研究の目的:

低血圧性脳卒中と頭蓋内出血 (ICH) のリスクを調査する.
高齢なAF患者 (≥90歳) のOAC治療の臨床的利益を評価する.

主な方法:

台湾の国民健康保険研究データベース (1996年−2015年) の遡及分析
AFと非AF患者の脳卒中とICHリスクの比較 (≥90歳).
AF患者におけるOAC (ワルファリン,NOAC) 使用と治療なしの比較または抗血小板剤の分析

主要な成果:

AF患者 (≥90) は,非AF患者と比較して高血性脳卒中リスク (HR1. 93) があったが,ICHリスクは同様であった.
AF患者におけるワルファリンの使用により,脳卒中のリスクが低下 (HR 0. 69) した.
NOACでは,ワルファリンと比較して,ICHのリスクが著しく低かった (HR 0. 32).

結論:

ウォルファリンは,非常に高齢のAF患者 (≥90) の脳卒中予防に臨床上の利益をもたらします.
NOACは,ワーファリンと比較して頭蓋内出血のリスクが低い.
高リスクの高齢者群では,OACs,特にNOACsが血栓予防に推奨されます.

キーワード:

90 年間心房細動高齢者頭蓋内出血発血性脳卒中

さらに関連する動画

05:12

Transesophageal Atrial Burst Pacing for Atrial Fibrillation Induction in Rats

Published on: February 14, 2022

3.8K

11:21

Robotic Ablation of Atrial Fibrillation

Published on: May 29, 2015

20.2K

関連する概念動画

01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

2.5K

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...

2.5K

03:03

Amyloid Fibrils

12.1K

Amyloid fibrils are aggregates of misfolded proteins. Under most circumstances, misfolded proteins are either refolded by chaperone proteins or degraded by the proteasome. However, in the case of a mutation or a disease, these proteins can accumulate to form large clusters and often further assemble to form elongated fibers, called fibrils.
Amyloid deposits were observed as early as 1639 in the liver and the spleen. In 1854, Rudolph Virchow performed iodine staining,...

Amyloid Fibrils

Fibril-associated Collagen

3.4K

Fibril-associated collagens are a type of collagens present in the extracellular matrix with interrupted triple helices or FACIT (Fibril-associated collagens interrupted triple-helices). FACIT help connect and attach the collagen fibrils with each other as well as with other proteins of the extracellular matrix.
For example, the type II collagen fibrils in cartilage have covalently bound type IX fibril-associated collagens at regular intervals. Other types of fibril-associated collagens are...

3.4K

01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

2.0K

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...

2.0K

01:11

Oral Cavity

3.2K

The oral cavity, or the mouth, is a complex structure in humans that plays a vital role in our day-to-day lives. Its role is not only in chewing and swallowing food; it also plays a role in speech and facial expressions.
Teeth: The teeth are the hardest structures in our bodies. Humans have two sets of teeth throughout their lifetime: deciduous (baby) teeth and permanent teeth. Each tooth consists of several parts: the crown (visible part), the root (embedded in the jaw), enamel (hard outer...