シガ　ツヨシ   Shiga Tsuyoshi   志賀　剛    所属   医学部 医学科（東京女子医科大学病院）    職種   客員教授
言語種別	日本語
発表タイトル	Antithrombotic Therapy in Patients with Renal Impairment
会議名	第81回日本循環器学会学術集会
主催者	日本循環器学会
学会区分	全国規模の学会
発表形式	口頭
発表者・共同発表者	◎志賀剛
発表年月日	2017/03/19
開催地 （都市, 国名）	金沢市
学会抄録	第81回日本循環器学会学術集会　プログラム集 426
概要	*ラウンドテーブルディスカッション 7 高リスク症例への抗血栓療法：合併症ゼロを目指す Renal impairment is an independent risk factor for stoke as well as atrial fibrillation (AF). Renal impairment is known to be a bleeding risk in patients receiving anticoagulant therapy. Warfarin decreased the risk of stroke/systemic thromboembolism for patients with renal impairment while the risk of bleeding was increased. It is unclear whether the benefit overweight the bleeding and which is more serious in these patients. There are few reports concerning the impact of degree of renal impairment on bleeding risk in Japanese patients receiving warfarin. Direct oral anticoagulants (DOACs) are reported to be associated with superior or similar stroke rates to warfarin, and all have reduced intracranial hemorrhage. These drugs are mainly or partially eliminated by kidney (dabigatran 80%, rivaroxaban 33%, apixaban 25%, edoxaban 50%). Despite increase in steady‒state trough blood drug concentration compared with patients with normal renal function, DOACs did not increase the risk of major bleeding including intracranial hemorrhage in AF patients with moderate renal impairment. Although there is the influence of renal impairment on pharmacokinetics of anticoagulants, therapeutic margins may exist. Cochrane meta-analysis reported that antiplatelet agents reduced the risk of myocardial infarction but not all-cause mortality or cardiovascular mortality in patients with renal impairment including end-stage renal disease (ESRD). The effect of anticoagulant and antiplatelet therapies for AF and cardiovascular disease in risked patients with ESRD is unclear