直接作用型経口抗凝固薬内服下の脳梗塞患者に対する遺伝子組み換え型プラスミノゲンアクティベータ静注療法の安全性について

• 資料種別: 博士論文
• タイトル: 直接作用型経口抗凝固薬内服下の脳梗塞患者に対する遺伝子組み換え型プラスミノゲンアクティベータ静注療法の安全性について
• 著者・編者: 岡田, 敬史
• 著者標目: 岡田, 敬史
• 出版事項: Wiley
• 出版年月日等: 2024-06-19
• 出版年（W3CDTF）: 2024-06-19
• 並列タイトル等: Intravenous Thrombolysis With Alteplase at 0.6 mg/kg in Patients With Ischemic Stroke Taking Direct Oral Anticoagulants
• 授与機関名: 鹿児島大学
• 授与年月日: 2024-06-19
• 授与年月日（W3CDTF）: 2024-06-19
• 報告番号: 甲総研第746号
• 学位: 博士(医学)
• 本文の言語コード: eng
• 件名標目: direct oral anticoagulants; ischemic stroke; low-dose alteplase; thrombolysis
• 対象利用者: 一般
• 一般注記: 出版タイプ： VoR; 博士論文全文, 博士論文要旨, 最終試験結果の要旨, 論文審査の要旨; BackgroundWe elucidated the safety of treatment with alteplase at 0.6 mg/kg within 24 hours for patients on direct oral anticoagulants (DOACs) before ischemic stroke onset.Methods and ResultsConsecutive patients with acute ischemic stroke who underwent intravenous thrombolysis using alteplase at 0.6 mg/kg from 2011 to 2021 were enrolled from our single‐center prospective stroke registry. We compared outcomes between patients taking DOACs and those not taking oral anticoagulants within 48 hours of stroke onset. The primary safety outcome was the rate of symptomatic intracranial hemorrhage with a ≥4‐point increase on the National Institutes of Health Stroke Scale score from baseline. The efficacy outcome was defined as 3‐month modified Rankin Scale score of 0 to 2 after stroke onset. Of 915 patients with acute ischemic stroke who received intravenous thrombolysis (358 women; median age, 76 years; median National Institutes of Health Stroke Scale score, 10), 40 patients took DOACs (6 took dabigatran, 8 took rivaroxaban, 16 took apixaban, and 10 took edoxaban) within 24 hours of onset and 753 patients did not take any oral anticoagulants. The rate of symptomatic intracranial hemorrhage was comparable between patients on DOACs and those not on oral anticoagulants (2.5% versus 2.4%, P=0.95). The rate of favorable outcomes was comparable between the 2 groups (59.4% versus 58.2%, P=0.46), although the admission National Institutes of Health Stroke Scale score was higher in patients on DOACs. No significant differences showed in any intracranial hemorrhage within 36 hours or mortality at 3 months.ConclusionsIntravenous thrombolysis would be safely performed for patients on DOACs following the recommendations of the Japanese guidelines.; Takashi Okada, Takeshi Yoshimoto, Shinichi Wada, Sohei Yoshimura, Tetsuya Chiba, Shuhei Egashira, Shunsuke Kimura, Masayuki Shiozawa, Manabu Inoue, Masafumi Ihara, Kazunori Toyoda, Hiroshi Takashima and Masatoshi KogaIntravenous Thrombolysis With Alteplase at 0.6 mg/kg in Patients With Ischemic Stroke Taking Direct Oral AnticoagulantsJournal of the American Heart Association 2022;11:e025809https://doi.org/10.1161/JAHA.122.025809
• 国立国会図書館永続的識別子: info:ndljp/pid/14556031; https://dl.ndl.go.jp/pid/14556031
• コレクション（共通）: 障害者向け資料
• コレクション（障害者向け資料：レベル1）: テキストデータ
• コレクション（個別）: 国立国会図書館デジタルコレクション > デジタル化資料 > 博士論文; https://dl.ndl.go.jp/collections/A00014
• 収集根拠: 博士論文（自動収集）
• 受理日（W3CDTF）: 2025-11-10T17:05:53+09:00
• 記録形式（IMT）: application/pdf
• オンライン閲覧公開範囲: 国立国会図書館内限定公開
• デジタル化資料送信: 図書館・個人送信対象外
• 遠隔複写可否（NDL）: 可
• 掲載誌（URI）: http://hdl.handle.net/10232/0002000364
• 連携機関・データベース: 国立国会図書館 : 国立国会図書館デジタルコレクション; https://dl.ndl.go.jp