所属 医学部 医学科（東京女子医科大学病院） 職種 助教
|発表タイトル||Quantitative Volumetric Comparison of Pulmonary Thrombus Reduction between Direct Oral Anticoagulant and Warfarin Treatment in Acute Phase of Symptomatic Patients|
|会議名||The 81st Annual Scientific Meeting of the Japanese Circulation Society (JCS2017)|
|主催者||Japanese Circulation Society|
|発表者・共同発表者||◎YOSHIDA Ayano, JUJO Kentaro, FUKUSHIMA Kenji, KIKUCHI Yasuhiro, MINAMI Yuichiro, YAMAMOTO Atsushi, HARUKI Shintaro, SHIMAZAKI Kensuke, ITANI Ryosuke, ARASHI Hiroyuki, TANAKA Hiroyuki, HAGIWARA Nobuhisa|
|学会抄録||PROGRAM JCS 2017 217|
|概要||BACKGROUNDS: Recent clinical trials revealed noninferiority of direct oral anticoagulant (DOAC) to standard therapy with warfarin in patients with pulmonary thromboembolism (PTE). However, there has been little report about the quantitative analysis of thrombus reduction in pulmonary arteries.
METHODS and RESULTS: This study included 28 consecutive patients with symptomatic PTE. All patients received intravenous bolus and continual heparin injection immediately after the diagnosis of PTE. Heparin administration was discontinued after the induction of edoxaban in DOAC group (n=15), or after prothrombin time-international normalized ratio (PT-INR) achieved therapeutic range in Warfarin group (n=13). Thrombus volume in pulmonary arteries was quantitatively analyzed by contrast-enhanced computed tomography scan, and compared before and 2 weeks after the induction of oral anticoagulants. Total amount of pulmonary thrombus was significantly decreased in DOAC group; whereas warfarin did not significantly affect the thrombus volume (reduction rate: -74% vs. -26%). Congealing fibrinogenolysis parameters including d-dimer, FDP and fibrinogen as well as TAT and PIC showed similar changes between the groups. However, two cases in Warfarin group showed increased PTE volume due to newly stuck thrombus from deep vein. Finally, only 1 case with major bleeding was observed in the Warfarin group.
CONCLUDIONS: Edoxaban monotherapy against PTE is safe and comparably effective to standard therapy with warfarin in terms of volume reduction in pulmonary artery thrombus.