直接投与された抗凝固剤を服用している心房細動患者に対する集中治療室入院時の抗凝固剤戦略による出血および血栓的結果の評価
Priya J Patel1, Mariah I Sigala1, Corey V Dinunno1
1Department of Pharmacy, Houston Methodist Hospital, TX, USA.
Journal of pharmacy practice
|September 6, 2025
まとめ
口服抗凝固剤 (DOACs) を直接服用している非弁動脈動脈症の重症患者では,パッケージインサートによる継続治療と代替策による治療は,重度の出血や血栓形成の有意な違いを示さなかった.
科学分野:
- クリティカル ケア 医療
- 心臓病科
- 薬理学について
背景:
- 以前から直接口服抗凝固剤 (DOAC) を服用していた重症の成人のICU入院の増加
- 非弁動脈動脈症 (NVAF) の患者で,ICUでDOACを服用する際の抗凝固戦略に関するコンセンサスの欠如.
- これらの患者の管理のための現在の臨床実践の変動性.
研究 の 目的:
- 以前 DOAC を服用していたNVAFのICU患者における2つの抗凝固策の間の重度の出血および血栓形成率を比較する.
- "パッケージ挿入" (製造者によって推奨される) と"非パッケージ挿入" (予防的または遅延された治療) のアプローチを評価する.
主な方法:
- リトロスペクティブコホート研究 (2019年1月から2023年8月)
- 集中治療室に入院後48時間以内にDOACにさらされたNVAF患者を含む.
- 血液出血のため入院した患者,または他の抗凝固薬の指示のために治療を受けた患者を除外します.
主要な成果:
- 353人の患者を分析した (122人のパッケージインサート,231人の非パッケージインサート).
- 複合性大出血および脳卒中/全身性血栓の発生率 (4. 1% 対 6. 1%,P=0. 437) には有意な差異はありません.
- 2つの抗凝固戦略の間で同様の結果が観察されました.
結論:
- 大量の出血,入院中の脳卒中,全身性血栓の差異は,パッケージインサートと非パッケージインサートの抗凝固方法の間にありません.
- 現在の研究結果では,重症のNVAF患者を対象にDOACを投与する際の戦略は支持されていません.
- この患者集団に対する根拠に基づいたガイドラインを確立するには,さらなる研究が必要である.
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