内科医として知っておくべき頭蓋内出血の現状と対策

抄録

• In the field of large clinical trials, the term “intracranial hemorrhage” includes not only hemorrhagic stroke but subdural hematoma. Each interpreter of trial results should pay an attention for the confusion of definitions, otherwise it may cause misunderstanding.

• In the field of large clinical trials, the term “intracranial hemorrhage” includes not only hemorrhagic stroke but subdural hematoma. Each interpreter of trial results should pay attention to the confusion of definitions, otherwise, it may cause misunderstanding.

• Recently, the bleeding complication during antithrombotic treatment becomes more important and serious due to the wide spreading of its usage.

The speaker revealed that the risk of intracerebral hemorrhage during aspirin therapy for secondary stroke prevention is significantly higher among patients with lacunar stroke. For patients with lacunar stroke or multiple microbleeds, neurologists must avoid aspirin or dual–antiplatelet therapy including aspirin.

Interestingly, the content of intracranial hemorrhage during DOAC anticoagulation is different among DOAC subtype, i.e. subdural hematoma is common in the patients with the thrombin inhibitor, whereas the intracerebral hemorrhage is much frequent among those with factor Xa inhibitors. The neurologists should select more suitable DOAC according to their patients' background and risk factors.

• At late years, some new drugs have been developed for the anticoagulation–rerated bleeding. Idarucizumab is the specific antidote (antibody Fc fragment) for dabigatran, and prothrombin complex concentrate (PCC) can be used for rapid warfarin neutralization. Andexanet alpha for factor Xa Inhibitors is just approved in the United States, and the clinical trial was completed also in Japan. Nevertheless, the immediate control of blood pressure is the still most important issue against a neurological deterioration for the patients with antithrombotic therapy–related intracranial hemorrhage.