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<title>血栓を制するものは心臓を制す！血栓循環器学Q＆A（電子版のみ） | 株式会社文光堂</title>


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<meta name="description" content="突然発症する心血管事故（急性冠症候群，脳卒中，肺血栓塞栓症等）はすべて血栓が関与している．すなわち，血栓を制すれば多くの心血管事故を予防できる．本書では，臨床での様々な状況における疑問にエキスパートが最新エビデンスをもとにわかりやすく回答する．心房細動やがん関連血栓塞栓症を含む血栓塞栓症，カテーテル治療等各処置への抗血栓療法まで，抗凝固療法・抗血小板療法のエッセンスをまとめた循環器医必携の一冊．">

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		<h1 class="catchCopy">循環器医が知っておくべき血栓コントロールの要点総まとめ！</h1>
		

		<h1 class="title">血栓を制するものは心臓を制す！血栓循環器学Q＆A（電子版のみ）<span class="version"></span></h1>
		<h2 class="subTitle">抗凝固療法・抗血小板療法のクリニカルクエスチョンに答える</h2>

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					編集：伊藤　浩（岡山大学大学院医歯薬学総合研究科循環器内科学教授）
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				<ul class="property"><li class="disc">B5判・164頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1947-2</li><li class="disc">2019年3月16日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">突然発症する心血管事故（急性冠症候群，脳卒中，肺血栓塞栓症等）はすべて血栓が関与している．すなわち，血栓を制すれば多くの心血管事故を予防できる．本書では，臨床での様々な状況における疑問にエキスパートが最新エビデンスをもとにわかりやすく回答する．心房細動やがん関連血栓塞栓症を含む血栓塞栓症，カテーテル治療等各処置への抗血栓療法まで，抗凝固療法・抗血小板療法のエッセンスをまとめた循環器医必携の一冊．</section><section class="preface">序文<br><br>　“血栓を制するものは心臓を制す．”<br>　この言葉の意味を循環器臨床に携わっている医師あるいはメディカルスタッフは理解していただけると思う．例えば，最近，心血管事故という言葉がよく使われるが，急性冠症候群，心原性脳梗塞そして肺血栓塞栓症は突然発症し，すべて血栓が関与している．すなわち，患者の生命を左右するのは狭窄の進行ではなく，急激に起こる血栓による閉塞であり，したがって事故，あるいはイベント，と呼ばれている．もし，血栓形成を抑制することができればほとんどの心血管事故が予防でき，生命予後の改善に貢献できる．そのことを踏まえ，冠動脈イベントや脳梗塞の予防には抗血小板薬，心原性塞栓や静脈血栓塞栓症の予防には抗凝固薬が必須とされている．<br>　血栓に関して新しい領域も出現してきた．腫瘍循環器学である．腫瘍循環器の中でも臨床の現場で最も多く遭遇するのは，静脈あるいは動脈の血栓塞栓症である．がんそれ自体あるいは抗がん剤治療が血栓症リスクを増大させることから，血栓症をどのようにコントロールするか生命予後の改善を考える上で喫緊の課題である．しかしながら，抗血小板薬や抗凝固薬には大出血という重大な副作用があり，特に高齢者や腎不全患者そしてがん患者では特に深刻な問題である．そのような患者を含め，抗血栓療法を施行する際に，我々は常に治療によるベネフィットとリスクのバランスを考慮する必要に迫られている．<br>　本書はさまざまな臨床状況における抗凝固薬と抗血小板薬の適応と使い方に関してエキスパートが最新エビデンスをもとにわかりやすく解説している．エビデンスに乏しくエキスパートオピニオンに頼らざるを得ない領域も少なくない．臨床におけるあらゆる状況を想定し，その時に役立つように治療戦略などに関して具体的な記述を心がけている．本書を実臨床に役立てることにより，一人でも多くの患者を救うことができれば，執筆者一同の大きな喜びである．<br><br>2019年2月<br>伊藤　浩</section><section class="indexes">Part.1　心血管イベントを予防する抗血小板療法<br>　CQ 1	▶一次予防に関して，糖尿病やCKDなどを合併するハイリスク患者の抗血小板療法はどのようにしたらよいでしょうか？<br>　CQ 2	▶一次予防に関して，血液透析患者の心血管イベント予防において抗血小板療法はどのようにしたらよいでしょうか？<br>　CQ 3	▶一次予防に関して，polyvascular disease（頸動脈プラークやABI＜0.9）患者の心血管イベント予防において抗血小板療法はどのようにしたらよいでしょうか？<br>　CQ 4	▶高齢者（75〜89歳）や超高齢者（90歳以上）の抗血小板療法をどのようにしたらよいでしょうか？<br>　CQ 5	▶PCI後の抗血小板薬2剤併用期間はどのようにしたらよいでしょうか？ <br>　　　　　　その後，単剤を残す場合についても教えてください<br>　CQ 6	▶CABG後の抗血小板療法，抗凝固療法をどのようにしたらよいでしょうか？<br>　CQ 7	▶AFを合併する患者のPCI後の抗血小板療法と抗凝固療法はどのようにしたらよいでしょうか？<br>　CQ 8	▶末梢動脈インターベンション後の抗血小板療法はどのようにしたらよいでしょうか？<br>　CQ 9	▶脳梗塞後の患者の抗血小板療法はどのようにしたらよいでしょうか？<br>　CQ 10	▶血小板機能のモニタリングはどのようにしたらよいでしょうか？ <br>　　　　　　モニタリングが必要なのはどのような症例でしょうか？<br>Part.2　静脈血栓塞栓症(VTE)に対する抗凝固療法<br>　CQ 11	▶急性肺血栓塞栓症（APE）患者を疑う所見は何でしょうか？また診断はどのように行いますか？<br>　CQ 12	▶PE患者のリスク層別化と治療はどのようにしたらよいでしょうか？ <br>　　　　　　そして治療における抗凝固療法と線溶療法の役割について教えてください<br>　CQ 13	▶PE患者で下大静脈フィルターを使用すべきはどのような患者でしょうか？ <br>　　　　　　挿入後の管理は何に注意したらよいでしょうか？<br>　CQ 14	▶PE発症後慢性期にかけての抗凝固療法はどのようにすべきでしょうか？ <br>　　　　　　そしていつまで続けますか？<br>　CQ 15	▶慢性血栓塞栓性肺高血圧症（CTEPH）を疑う所見は何でしょうか？<br>　　　　　　診断はどのように行いますか？<br>　CQ 16	▶CTEPH患者の治療はどのようにしたらよいでしょうか？ <br>　　　　　　また抗凝固療法はどのようにしたらよいでしょうか？<br>　CQ 17	▶CTEPH患者に対するバルーン肺動脈形成術（BPA）はどのような治療で，適応と成績はどのようなものでしょうか？ また抗凝固療法はどのようにしたらよいでしょうか？<br>　CQ 18	▶CTEPH患者の慢性期治療と経過観察はどのようにしたらよいでしょうか？<br>　CQ 19	▶深部静脈血栓症（DVT）はどのような患者で疑い，どのように治療するのでしょうか？<br>　CQ 20	▶災害時のDVTに対する対策はどのようにしたらよいでしょうか？<br>　CQ 21	▶Fontan術後の抗凝固療法をどのようにしたらよいでしょうか？<br>Part.3　心房細動(AF)そしてESUSに対する抗血栓療法<br>　CQ 22	▶DOAC時代になりAF患者の抗凝固療法の適応はどうなったのでしょうか？<br>　CQ 23	▶DOACの間で使い方の違いはあるのでしょうか？<br>　CQ 24	▶日本人における脳梗塞リスク層別化にはCHADS2あるいはCHA2DS2-VASc，どちらがよいでしょうか？<br>　CQ 25	▶超高齢者，腎機能不全を合併するAF患者の抗凝固療法はどのようにすべきでしょうか？<br>　CQ 26	▶AF患者において脳梗塞急性期の抗凝固療法をどのようにしたらよいでしょうか？<br>　CQ 27	▶Embolic Stroke of Undetermined Sources（ESUS）はどのような時に疑われるのでしょうか？ <br>　　　　　　診断そして治療はどのようなことが推奨されていますか？<br>　CQ 28	▶潜在性AFを検出すべき病態にどのようなものがあるのでしょうか？ <br>　　　　　　そしてその診断法にはどのようなものがありますか？<br>　CQ 29	▶ワルファリンが必要なAFの病態にはどのようなものがあるのでしょうか？<br>　CQ 30	▶洞調律の収縮不全患者において抗凝固療法あるいは抗血小板療法はどのようにしたらよいのでしょうか？ <br>　CQ 31	▶担がん患者のAFに対する抗凝固療法はどのようにしたらよいでしょうか？<br>　CQ 32	▶成人先天性心疾患の心房性頻拍症に対する抗凝固療法をどのようにしたらよいでしょうか？<br>　CQ 33	▶透析のAF患者に対する抗凝固療法はどのようにしたらよいでしょうか？<br>Part.4　がん関連血栓症(CAT)における抗凝固療法<br>　CQ 34	▶がん関連血栓症（CAT）の病態と機序について教えてください<br>　CQ 35	▶がん患者においてどのような時にCATを疑い，どのように診断したらよいでしょうか？<br>　CQ 36	▶CATはどのようながんに多いのでしょうか？ そしてリスク層別化をどのように行うのでしょうか？<br>　CQ 37	▶欧米では低分子ヘパリン皮下注がCATの標準治療です．ワルファリンではなくなぜ低分子ヘパリンなのでしょうか？<br>　CQ 38	▶がん患者術後のVTEはどのような手術で多いのでしょうか？ その対策はどのようにしたらよいのでしょうか？<br>　CQ 39	▶CATに対する抗凝固療法はどのようにしたらよいでしょうか？<br>　CQ 40	▶CATの動脈血栓塞栓症はどのようなものでしょうか？ どう治療したらよいのでしょうか？<br>　CQ 41	▶血栓形成を注意すべき抗がん剤はありますか？<br>Part.5　出血合併症とその対処<br>　CQ 42	▶抗凝固療法中の大出血：頭蓋内出血と緊急対応について教えてください<br>　CQ 43	▶抗凝固療法中の大出血：消化管出血と緊急対応について教えてください<br>　CQ 44	▶抗血小板療法中の大出血：頭蓋内出血と緊急対応について教えてください<br>　CQ 45	▶抗血小板療法中の大出血：消化管出血と緊急対応について教えてください<br>　CQ 46	▶脳出血，消化管出血後に抗血小板療法と抗凝固療法をいつ再開させたらよいのでしょうか？<br>Part.6　処置に伴う抗血栓療法<br>　CQ 47	▶経カテーテル大動脈弁留置術（TAVI）における抗血栓療法をどのようにしたらよいでしょうか？<br>　CQ 48	▶心房中隔欠損症に対するカテーテル閉鎖術後の抗凝固療法，抗血小板療法をどのようにしたらよいでしょうか？<br>　CQ 49	▶消化器内視鏡検査が予定されているAF患者の抗凝固療法はどのようにしたらよいでしょうか？<br>　CQ 50	▶AF患者に直流除細動を行うときの注意点と抗凝固療法はどのようにしたらよいでしょうか？<br>　CQ 51	▶AFへのカテーテルアブレーション時に抗凝固療法はどのようにしたらよいでしょうか？<br>　CQ 52	▶周術期のヘパリンブリッジは必要でしょうか？ DOACではどのように対応できるのでしょうか？<br>　CQ 53	▶DOACの中和はどのようにしたらよいでしょうか？<br>　CQ 54	▶ワルファリン療法に対して中和はどのようにしたらよいでしょうか？<br>索　引</section></article>
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