フレイル高齢者に対する心臓病治療の問題点 ₆₅ ₂₃% ₁ ₁ ₁ 心臓 Vol. 49 No.6(2017)
₃ ₁ ₂ ₃₇ DOACs TIA ₈ CHADS ₂ ₉ CHA ₂ DS ₂ VASc ₁₀ ₁₁ CHA ₂ DS ₂ VASc ₁₂ AF ₁₃ AF CHA ₂ DS ₂ VASc HAS BLED ₁₄ HAS BLED K Ⅹa Warfarin Dabigatran Rivaroxaban Apixaban Edoxaban DOACDirect oral anticoagulants
PCI ₁₅ HAS BLED ₁₆ ₁₇ ₁₈ ₁ cerebral small vessel disease ₁₉ ₈₀₁₀₀% Fibrinoid necrosis Lipohyalinosis Microatheroma Microaneurysms Segmental arterial disorganization Sporadic, genetic CAA CADASIL, CARASIL, MELAS, Fabrys disease etc. Primary angitis of the CNS, Wegeners granulomatosis, Churg Strauss syndrome, microscopic PN, Henoch Schönlein purpura etc. Post radiation angiopathy, Non amyloid microvessel degeneration in AD ₁₉ 心臓 Vol. 49 No.6(2017)
MRI T₂ MBs micro bleeds ₂₀ PT INR PT INR ₂ ₇₀ PT INR ₁. ₆ ₂. ₆ CYP₂C₉ VKORC₁ PT INR Ⅹa DOACs Ⅹa DOACs K DOACs ₄ DOACs Ⅹa ₄₇ 文献 ₁Wolf PA, Abbott RD, Kannel WBAtrial fibrillation as an independent risk factor for strokethe Framingham Study. Stroke ₁₉₉₁22₉₈₃ ₉₈₈ ₂Pearce LA, Hart RG, Halperin JLAssessment of three schemes for stratifying stroke risk in patients with nonvalvular atrial fibrillation. Am J Med ₂₀₀₀109₄₅ ₅₁
₃ACTIVE writing group on behalf of the ACTIVE investigatorsclopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events ACTIVE Wa randomised controlled trial. Lancet ₂₀₀₆367₁₉₀₃ ₁₉₁₂ ₄Connolly SJ, Ezekowitz MD, Yusuf S, et alfor the RE LY steering committee and investigatorsdabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med ₂₀₀₉361₁₁₃₉ ₁₁₅₁ ₅Patel MR, Mahaffey KW, Garg J, et aland the ROCK- ET AF steering committee, for the ROCKET AF investigatorsrivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med ₂₀₁₁365₈₈₃ ₈₉₁ ₆Connolly SJ, Eikelboom J, Joyner C, et alaverroes Steering Committee and InvestigatorsApixaban in patients with atrial fibrillation. N Engl J Med ₂₀₁₁ 364₈₀₆ ₈₁₇ ₇Giugliano RP, Ruff CT, Braunwald E, et alengage AF TIMI ₄₈ InvestigatorsEdoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med ₂₀₁₃ 369₂₀₉₃ ₂₁₀₄ ₈Pearce LA, Hart RG, Halperin JLAssessment of thre schemes for stratifying stroke risk in patients with nonvalvular atrial fibrillation. Am J Med ₂₀₀₀109₄₅ ₅₁ ₉Gage BF, Waterman AD, Shannon W, et alvalidation of clinical classification schemes for predicting stroke results from the National Registry of Atrial Fibrillation. JAMA ₂₀₀₁285₂₈₆₄ ₂₈₇₀ ₁₀Boriani G, Botto GL, Padeletti L, et alitalian AT ₅₀₀ Registry InvestigatorsImproving stroke risk stratification using the CHADS₂ and CHA₂DS₂ VASc risk scores in patients with paroxysmal atrial fibrillation by continuous arrhythmia burden monitoring. Stroke ₂₀₁₁42₁₇₆₈ ₁₇₇₀ ₁₁Annoni G, Mazzola PReal world characteristics of hospitalized frail elderly patients with atrial fibrillationcan we improve the current prescription of anticoagulants? J Geriatr Cardiol ₂₀₁₆13₂₂₆ ₂₃₂ ₁₂Nguyen TN, Cumming RG, Hilmer SNThe Impact of Frailty on Mortality, Length of Stay and Re hospitalisation in Older Patients with Atrial Fibrillation. Heart Lung Circ ₂₀₁₆25₅₅₁ ₅₅₇ ₁₃Hamatani Y, Ogawa H, Uozumi R, et allow Body Weight Is Associated With the Incidence of Stroke in Atrial Fibrillation Patients Insight From the Fushimi AF Registry. Circ J ₂₀₁₅79₁₀₀₉ ₁₀₁₇ ₁₄Pisters R, Lane DA, Nieuwlaat R, et ala novel user friendly score HAS BLEDto assess ₁ year risk of major bleeding in patients with atrial fibrillationthe Euro Heart Survey. Chest ₂₀₁₀138₁₀₉₃ ₁₁₀₀ ₁₅Hart RG, Pearce LA, Rothbart RM, et alstroke with intermittent atrial fibrillationincidence and predictors during aspirin therapy. Stroke Prevention in Atrial Fibrillation Investigators. J Am Coll Cardiol ₂₀₀₀35 ₁₈₃ ₁₈₇ ₁₆Gaist D, García Rodríguez LA, Hellfritzsch M et al Association of Antithrombotic Drug Use With Subdural Hematoma Risk. JAMA ₂₀₁₇317₈₃₆ ₈₄₆ ₁₇Poli D, Antonucci E, Testa S, et alitalian Federation of Anticoagulation ClinicsBleeding risk in very old patients on vitamin K antagonist treatmentresults of a prospective collaborative study on elderly patients followed by Italian Centres for Anticoagulation. Circulation ₂₀₁₁124₈₂₄ ₈₂₉ ₁₈Steffel J, Giugliano RP, Braunwald E, et aledoxaban Versus Warfarin in Atrial Fibrillation Patients at Risk of FallingENGAGE AF TIMI ₄₈ Analysis. J Am Coll Cardiol ₂₀₁₆68₁₁₆₉ ₁₁₇₈ ₁₉Pantoni LCerebral small vessel diseasefrom pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol ₂₀₁₀9₆₈₉ ₇₀₁ ₂₀Kato H, Izumiyama M, Izumiyama K, et alsilent cerebral microbleeds on T₂ weighted MRIcorrelation with stroke subtype, stroke recurrence, and leukoaraiosis. Stroke ₂₀₀₂33₁₅₃₆ ₁₅₄₀ 心臓 Vol. 49 No.6(2017)