マラソンレクチャー
脳卒中薬物治療の最前線
キーワード:
antiplatelet therapy,
anticoagulant,
P2Y12 inhibitor,
CYP2C19 gene polymorphism,
platelet aggregation,
prasugrel
2025 年 42 巻 4 号 p. 720-724
詳細
2025 年 42 巻 4 号 p. 720-724
Antiplatelet agents and anticoagulants for ischemic stroke are selected according to stroke subtype and complications. Large artery atherosclerosis has a highest recurrence rate among ischemic stroke subtypes, and dual antiplatelet therapy is widely used for treatment in the acute phase and P2Y12 inhibitors for secondary prevention. The inhibitory effect of platelet aggregation by clopidogrel is greatly affected by CYP2C19 gene polymorphisms, but prasugrel is a P2Y12 inhibitor that has a rapid onset of action, is not affected by CYP2C19 gene polymorphisms, and can be expected to have a stable platelet aggregation suppression effect. Although it is difficult to evaluate platelet aggregation and CYP2C19 gene polymorphisms by routine testing, further accumulation of prasugrel treatment outcomes is required, especially in patients with large artery atherosclerosis, in which a high degree of platelet aggregation is predicted.
