4．転倒や出血を考慮した抗血栓薬管理
高齢者では転倒・転落による死亡者数は不慮の事故の中で最も多い．抗血栓療法は循環器疾患をそしてそれに伴う転倒も予防するが，同時に出血を宿命的に合併する．転倒は患者側の原因と環境原因が重なって起こることを認識してリスクを評価し，転倒リスクに関連する薬剤の処方などを抑制する．また適応があるなら新規経口抗凝固薬などより安全な薬剤を処方し，極端に虚弱な患者には抗血栓療法を控えることも考慮するなど総合的な対応が重要である．...
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| Published in | 日本老年医学会雑誌 Vol. 59; no. 3; pp. 305 - 311 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本老年医学会
25.07.2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-9173 |
| DOI | 10.3143/geriatrics.59.305 |
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| Abstract | 高齢者では転倒・転落による死亡者数は不慮の事故の中で最も多い．抗血栓療法は循環器疾患をそしてそれに伴う転倒も予防するが，同時に出血を宿命的に合併する．転倒は患者側の原因と環境原因が重なって起こることを認識してリスクを評価し，転倒リスクに関連する薬剤の処方などを抑制する．また適応があるなら新規経口抗凝固薬などより安全な薬剤を処方し，極端に虚弱な患者には抗血栓療法を控えることも考慮するなど総合的な対応が重要である． |
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| AbstractList | 高齢者では転倒・転落による死亡者数は不慮の事故の中で最も多い．抗血栓療法は循環器疾患をそしてそれに伴う転倒も予防するが，同時に出血を宿命的に合併する．転倒は患者側の原因と環境原因が重なって起こることを認識してリスクを評価し，転倒リスクに関連する薬剤の処方などを抑制する．また適応があるなら新規経口抗凝固薬などより安全な薬剤を処方し，極端に虚弱な患者には抗血栓療法を控えることも考慮するなど総合的な対応が重要である． |
| Author | 矢坂, 正弘 杉森, 宏 岡田, 靖 森, 興太 |
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| References | 11) Toyoda K, Uchiyama S, Yamaguchi T, Easton JD, Kimura K, Hoshino H, et al.: Dual antiplatelet therapy using cilostazol for secondary prevention in patients with high-risk ischaemic stroke in Japan: a multicentre, open-label, randomised controlled trial. Lancet Neurol 2019; 18: 539-548. 5) Steffel J, Giugliano RP, Braunwald E, Murphy SA, Mercuri M, Choi Y, et al.: Edoxaban Versus Warfarin inAtrial Fibrillation Patients at Risk of FallingENGAGE AF-TIMI 48 Analysis. J Am Coll Cardiol 2016; 68 (11): 1169-1178. 7) Vargas ER, Sposato LA, Lee SAW, Hachinski V, Cipriano LE: Anticoagulation therapy for atrial fibrillation in patients with Alzheimer's disease. Stroke 2018; 49: 2844-2850. 12) Bath PM, Woodhouse LJ, Appleton JP, Beridze M, Christensen H, Dineen RA, et al.: Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischemia (TARDIS): a randomized, open-label, phase 3 superiority trial. Lancet 2018; 391: 850-859. 14) Visvanathan A, Dennis M, Mead G, Whiteley WN, Lawton J, Doubal FN: Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions? Int J Stroke 2017; 12 (9): 920-922. 1) Phelan EA, Mahoney JE, Voit JC, Stevens JA: Assessment and Management of Fall Risk in Primary Care Settings. Med Clin North Am 2015; 99 (2): 281-293 (doi:10.1016/j.mcna.2014.11.004). 3) https://www.cdc.gov/steadi/index.html (accessed 2022-5-1). 10) Wang Y, Pan Y, Zhao X, Li H, Wang D, Johnston SC, et al.: Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) Trial: One-Year Outcomes. Circulation 2015; 132 (1): 40-46. 4) Gage BF, Birman-Deych E, Kerzner R, Radford MJ, Nilasena DS, Rich MW: Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med 2005; 118: 612-617. 8) Yasuda S, Kaikita K, Akao M, Ako J, Matoba T, Nakamura M, et al.: Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease. N Engl J Med 2019; 381: 1103-1113. 13) 日本脳卒中学会 脳卒中ガイドライン委員会: 脳卒中治療ガイドライン2021, 協和企画, 東京, 2021. 2) https://www.tentouyobou.jp/aboutus/tools.html (accessed 2022-5-1). 9) CAPRIE Steering Committee: A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348 (9038): 1329-1339. 6) Wong EKC, Belza C, Naimark DMJ, Straus SE, Wijeysundera HC: Cost-effectiveness of antithrombotic agents for atrial fibrillation in older adults at risk for falls: a mathematical modelling study. CMAJ Open 2020. (doi:10.9778/cmajo.20200107). |
| References_xml | – reference: 6) Wong EKC, Belza C, Naimark DMJ, Straus SE, Wijeysundera HC: Cost-effectiveness of antithrombotic agents for atrial fibrillation in older adults at risk for falls: a mathematical modelling study. CMAJ Open 2020. (doi:10.9778/cmajo.20200107). – reference: 5) Steffel J, Giugliano RP, Braunwald E, Murphy SA, Mercuri M, Choi Y, et al.: Edoxaban Versus Warfarin inAtrial Fibrillation Patients at Risk of FallingENGAGE AF-TIMI 48 Analysis. J Am Coll Cardiol 2016; 68 (11): 1169-1178. – reference: 14) Visvanathan A, Dennis M, Mead G, Whiteley WN, Lawton J, Doubal FN: Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions? Int J Stroke 2017; 12 (9): 920-922. – reference: 7) Vargas ER, Sposato LA, Lee SAW, Hachinski V, Cipriano LE: Anticoagulation therapy for atrial fibrillation in patients with Alzheimer's disease. Stroke 2018; 49: 2844-2850. – reference: 4) Gage BF, Birman-Deych E, Kerzner R, Radford MJ, Nilasena DS, Rich MW: Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med 2005; 118: 612-617. – reference: 3) https://www.cdc.gov/steadi/index.html (accessed 2022-5-1). – reference: 11) Toyoda K, Uchiyama S, Yamaguchi T, Easton JD, Kimura K, Hoshino H, et al.: Dual antiplatelet therapy using cilostazol for secondary prevention in patients with high-risk ischaemic stroke in Japan: a multicentre, open-label, randomised controlled trial. Lancet Neurol 2019; 18: 539-548. – reference: 10) Wang Y, Pan Y, Zhao X, Li H, Wang D, Johnston SC, et al.: Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) Trial: One-Year Outcomes. Circulation 2015; 132 (1): 40-46. – reference: 2) https://www.tentouyobou.jp/aboutus/tools.html (accessed 2022-5-1). – reference: 8) Yasuda S, Kaikita K, Akao M, Ako J, Matoba T, Nakamura M, et al.: Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease. N Engl J Med 2019; 381: 1103-1113. – reference: 1) Phelan EA, Mahoney JE, Voit JC, Stevens JA: Assessment and Management of Fall Risk in Primary Care Settings. Med Clin North Am 2015; 99 (2): 281-293 (doi:10.1016/j.mcna.2014.11.004). – reference: 9) CAPRIE Steering Committee: A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348 (9038): 1329-1339. – reference: 12) Bath PM, Woodhouse LJ, Appleton JP, Beridze M, Christensen H, Dineen RA, et al.: Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischemia (TARDIS): a randomized, open-label, phase 3 superiority trial. Lancet 2018; 391: 850-859. – reference: 13) 日本脳卒中学会 脳卒中ガイドライン委員会: 脳卒中治療ガイドライン2021, 協和企画, 東京, 2021. |
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| Title | 4．転倒や出血を考慮した抗血栓薬管理 |
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