臨床神経学

<シンポジウム16―2>心房細動患者の抗凝固療法―新時代への対応―

心房細動と脳塞栓症:急性期治療の実際と問題点

矢坂 正弘

九州医療センター脳血管内科〔〒810―8563 福岡県福岡市中央区地行浜1―8―1〕

In addition to the general treatment, rt-PA intravenous thrombolysis, intraarterial thrombolysis, brain protecting therapy with edaravone, glycerol treatment against brain edema, and immediate anticoagulant therapy should be considered in acute phase of cardioembolic stroke. The rt-PA intravenous thrombolysis within three hours of onset is recommended in acute stroke patients who meet criteria for the therapy. Because the efficacy of immediate anticoagulation in acute cardioembolic stroke has not been established yet, it depends on balance of risk and benefit in each patient whether immediate anticoagulant therapy should be commenced or not. When we start anticoagulation with warfarin, heparin which has rapid action should be administered at the same time until PT-INR increases into therapeutic range to avoid acute recurrent stroke. However when we start with dabigatran which has rapid action, heparin is usually not required.
Full Text of this Article in Japanese PDF (246K)

(臨床神経, 51:1001−1003, 2011)
key words:心原性脳塞栓症,心房細動,rt-PA血栓溶解療法,ワルファリン,ダビガトラン

(受付日:2011年5月19日)