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心房細動 の 中 で の 脳卒中 の 予防:将来 を 見る
Aristeidis H Katsanos1, Hooman Kamel2, Jeff S Healey3
1Division of Neurology, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Canada (A.H.K., R.G.H.).
Circulation
|December 14, 2020
まとめ
心房細動の脳卒中予防の進歩には より安全な抗凝固剤や 左心房閉塞のような新しい治療法が含まれています 進行中の研究は,最適なタイミング,出血リスク,心臓栓塞性脳卒中の予防のための新しい治療法を調査しています.
科学分野:
- 心臓病科
- 神経学
- 薬理学について
背景:
- 動脈動 (AF) は血栓性脳卒中の主な原因で,重度の神経学的欠陥と高い再発率をもたらします.
- AF患者における抗凝固薬による脳卒中の再発および出血の長期的なリスクは,進展しているにもかかわらず,依然として存在しています.
- 現在の予防戦略は,有効性と安全性のバランスを取るために,継続的に改良する必要があります.
研究 の 目的:
- 過去30年の脳卒中予防における主要な進歩をレビューする.
- 現在臨床試験で調査されている新しい診断と治療のアプローチを強調する.
- AFにおける心臓栓塞性脳卒中の二次予防のための新たな治療法について議論する.
主な方法:
- 心房細動の脳卒中予防における主要な進歩のレビュー
- 進行中の臨床試験に重点を置く
- 非ビタミンKアンタゴーニスト経口抗凝固剤 (NOAC) と左心房閉塞 (LAAO) の現在の証拠の分析
主要な成果:
- 非ビタミンKの抗凝固薬 (NOACs) は,非弁性AFにおける脳卒中の予防にワーファリンより安全で,同等に有効です.
- NOACは,リウマチ性心疾患,原因不明の脳卒中,認知機能低下の予防のために研究されています.
- 左心房閉塞 (LAAO) は,特に高出血リスクの患者で,一次性および二次性脳卒中予防のために評価されています.
結論:
- NOACは,AFにおける脳卒中の予防において,ワーファリンよりも有意な改善を示しています.
- LAAOや新薬剤 (コルキシン,XIa因子阻害剤) のような新興戦略は,将来の治療手段を提供している.
- AF脳卒中の予防を最適化するために 集中的な研究が進行中です その中にはモニタリング,早期発見,そして 適応した治療法が含まれます
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