抗凝固療法中に発症した虚血性脳卒中
急性期虚血性脳卒中患者のうち，発症前にワルファリンを内服していた連続197例を，脳卒中治療ガイドライン2004の推奨値に基づき，来院時PT-INRにより治療域群と非治療域群に分け，臨床像を比較した．今回発症時病型では，心原性脳塞栓症は非治療域群（61％ vs 77％；p=0.03）,ラクナ梗塞は治療域群（17％ vs 6％；p=0.01）において，その比率が高かった．心原性脳塞栓症既往例では，治療域群において，入院時NIHSS（10 vs 18；p=0.005）,退院時Barthel index（54 vs 33；p=0.03）とmodified Rankin Scale（3 vs 4；p=0...
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| Published in | 臨床神経学 Vol. 50; no. 7; pp. 455 - 460 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.50.455 |
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| Abstract | 急性期虚血性脳卒中患者のうち，発症前にワルファリンを内服していた連続197例を，脳卒中治療ガイドライン2004の推奨値に基づき，来院時PT-INRにより治療域群と非治療域群に分け，臨床像を比較した．今回発症時病型では，心原性脳塞栓症は非治療域群（61％ vs 77％；p=0.03）,ラクナ梗塞は治療域群（17％ vs 6％；p=0.01）において，その比率が高かった．心原性脳塞栓症既往例では，治療域群において，入院時NIHSS（10 vs 18；p=0.005）,退院時Barthel index（54 vs 33；p=0.03）とmodified Rankin Scale（3 vs 4；p=0.04）が良好であった． |
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| AbstractList | 急性期虚血性脳卒中患者のうち，発症前にワルファリンを内服していた連続197例を，脳卒中治療ガイドライン2004の推奨値に基づき，来院時PT-INRにより治療域群と非治療域群に分け，臨床像を比較した．今回発症時病型では，心原性脳塞栓症は非治療域群（61％ vs 77％；p=0.03）,ラクナ梗塞は治療域群（17％ vs 6％；p=0.01）において，その比率が高かった．心原性脳塞栓症既往例では，治療域群において，入院時NIHSS（10 vs 18；p=0.005）,退院時Barthel index（54 vs 33；p=0.03）とmodified Rankin Scale（3 vs 4；p=0.04）が良好であった． |
| Author | 稲富, 雄一郎 内野, 誠 平野, 照之 橋本, 洋一郎 米原, 敏郎 井上, 泰輝 |
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| References | 5) Stroke Prevention in Atrial Fibrillation Investigators: Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: stroke prevention in atrial fibrillation III randomized clinical trial. Lancet 1996;348:633-638. 8) Lyden PD, Lu M, Levine SR, et al. A modified national institutes of health stroke scale for use in stroke clinical trials: preliminary reliability and validity. Stroke 2001;32:1310-1317. 14) Evans A, Perez I, Yu G, et al. Secondary stroke prevention in atrial fibrillation. Lessons from clinical practice. Stroke 2000;32:2106-2111. 12) Hylek EM, Go AS, Chang Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 2003;349:1019-1026. 13) Evans A, Perez I, Yu G, et al. Should stroke subtype influence anticoagulation decisions to prevent recurrence in stroke patients with atrial fibrillation? Stroke 2001;32:2828-2832. 4) Yasaka M, Minematsu K, Yamaguchi T. Optimal intensity of international normalized ratio in warfarin therapy for secondary prevention of stroke in patients with non-valvular atrial fibrillation. Inter Med 2001;40:1183-1188. 11) Mahoney FI, Barthel DW. Functional evaluation: the barthel index. A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md Med State J 1965;14:61-65. 19) Toyoda K, Yasaka M, Iwade K, et al. Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease. A prospective, multicenter, observational study. Stroke 2008;39:1740-1745. 10) van Swieten JC, Koudstaal PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-607. 2) Hart RG, Benavente O, McBride R, et al. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 1999;131:492-501. 7) 篠原幸人, 吉本高志, 福内靖男ら. 脳卒中治療ガイドライン2004. 東京: 協和企画; 2004. p. 81-85. 15) Mohr JP, Thompson JLP, Lazar RM, et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001;345:1444-1451. 1) EAFT (European Atrial Fibrillation Trial) Study Group. Secondary prevention in nonrheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993;342:1255-1262. 9) National Institute of Neurological Disorders and Stroke: Classification of cerebrovascular diseases III. Stroke 1990;21:637-676. 6) Mant J, Hobbs FDR, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham atrial fibrillation treatment of the aged study, BAFTA): a randomised controlled trial. Lancet 2007;370:493-503. 18) Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004;364:331-337. 17) Minematsu K, Yamaguchi T, Omae T. 'Spectacular shrinking deficit': rapid recovery from a major hemispheric syndrome by migration of an embolus. Neurology 1992;42:157-162. 3) Yamaguchi T for Japanese nonvalvular atrial fibrillation-embolism secondary prevention cooperative study group. Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation: a multicenter, prospective, randomized trial. Stroke 2000;31:817-821. 16) Lee LJ, Kidwell CS, Alger J, et al. Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke 2000;31:1081-1089. |
| References_xml | – reference: 7) 篠原幸人, 吉本高志, 福内靖男ら. 脳卒中治療ガイドライン2004. 東京: 協和企画; 2004. p. 81-85. – reference: 1) EAFT (European Atrial Fibrillation Trial) Study Group. Secondary prevention in nonrheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993;342:1255-1262. – reference: 12) Hylek EM, Go AS, Chang Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 2003;349:1019-1026. – reference: 18) Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004;364:331-337. – reference: 19) Toyoda K, Yasaka M, Iwade K, et al. Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease. A prospective, multicenter, observational study. Stroke 2008;39:1740-1745. – reference: 9) National Institute of Neurological Disorders and Stroke: Classification of cerebrovascular diseases III. Stroke 1990;21:637-676. – reference: 15) Mohr JP, Thompson JLP, Lazar RM, et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001;345:1444-1451. – reference: 17) Minematsu K, Yamaguchi T, Omae T. 'Spectacular shrinking deficit': rapid recovery from a major hemispheric syndrome by migration of an embolus. Neurology 1992;42:157-162. – reference: 11) Mahoney FI, Barthel DW. Functional evaluation: the barthel index. A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md Med State J 1965;14:61-65. – reference: 10) van Swieten JC, Koudstaal PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-607. – reference: 13) Evans A, Perez I, Yu G, et al. Should stroke subtype influence anticoagulation decisions to prevent recurrence in stroke patients with atrial fibrillation? Stroke 2001;32:2828-2832. – reference: 5) Stroke Prevention in Atrial Fibrillation Investigators: Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: stroke prevention in atrial fibrillation III randomized clinical trial. Lancet 1996;348:633-638. – reference: 3) Yamaguchi T for Japanese nonvalvular atrial fibrillation-embolism secondary prevention cooperative study group. Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation: a multicenter, prospective, randomized trial. Stroke 2000;31:817-821. – reference: 4) Yasaka M, Minematsu K, Yamaguchi T. Optimal intensity of international normalized ratio in warfarin therapy for secondary prevention of stroke in patients with non-valvular atrial fibrillation. Inter Med 2001;40:1183-1188. – reference: 16) Lee LJ, Kidwell CS, Alger J, et al. Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke 2000;31:1081-1089. – reference: 6) Mant J, Hobbs FDR, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham atrial fibrillation treatment of the aged study, BAFTA): a randomised controlled trial. Lancet 2007;370:493-503. – reference: 14) Evans A, Perez I, Yu G, et al. Secondary stroke prevention in atrial fibrillation. Lessons from clinical practice. Stroke 2000;32:2106-2111. – reference: 2) Hart RG, Benavente O, McBride R, et al. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 1999;131:492-501. – reference: 8) Lyden PD, Lu M, Levine SR, et al. A modified national institutes of health stroke scale for use in stroke clinical trials: preliminary reliability and validity. Stroke 2001;32:1310-1317. |
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| Snippet | 急性期虚血性脳卒中患者のうち，発症前にワルファリンを内服していた連続197例を，脳卒中治療ガイドライン2004の推奨値に基づき，来院時PT-INRにより治療域群と非治療域群に分け，臨床像を比較した．今回発症時病型では，心原性脳塞栓症は非治療域群（61％ vs 77％；p=0.03）,ラクナ梗塞は治療域群（17％ vs... |
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| SubjectTerms | 二次予防 再発 抗凝固療法 脳梗塞 |
| Title | 抗凝固療法中に発症した虚血性脳卒中 |
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