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

Material type: 博士論文

Author: 岡田, 敬史

Publisher: Wiley

Date granted: 2024-06-19

Material Format: Digital

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Degree grantor and degree: 鹿児島大学,博士(医学)

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Note (General)：: 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Background We elucidated the safety of treatment with alteplase at 0.6 mg/kg within 24 hours for patients ...

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Material Type: 博士論文
Title: 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
Author/Editor: 岡田, 敬史
Author Heading: 岡田, 敬史
Publication, Distribution, etc.: Wiley
Alternative Title: Intravenous Thrombolysis With Alteplase at 0.6 mg/kg in Patients With Ischemic Stroke Taking Direct Oral Anticoagulants
Degree Grantor: 鹿児島大学
Date Granted: 2024-06-19
Dissertation Number: 甲総研第746号
Degree Type: 博士(医学)
Text Language Code: eng
Subject Heading: direct oral anticoagulants
ischemic stroke
low-dose alteplase
thrombolysis
Target Audience: 一般
Note (General): 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
Background We 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 Results Consecutive 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. Conclusions Intravenous 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 Koga Intravenous Thrombolysis With Alteplase at 0.6 mg/kg in Patients With Ischemic Stroke Taking Direct Oral Anticoagulants Journal of the American Heart Association 2022;11:e025809 https://doi.org/10.1161/JAHA.122.025809
Format (IMT): application/pdf
Source: Diss_OKADA_Takashi_ISK746_2024.pdf （fulltext）
https://ir.kagoshima-u.ac.jp/record/2000364/files/Diss_OKADA_Takashi_ISK746_2024.pdf
Access Restrictions: インターネット公開
Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）
https://irdb.nii.ac.jp
Original Data Provider (Database): 鹿児島大学 : 鹿児島大学リポジトリ