@article{oai:niigata-u.repo.nii.ac.jp:00023756, author = {服部, 晃 and 長山, 礼三 and 柴田, 昭 and 伊藤, 粋子 and 渡部, 透 and 本間, 義明 and 飯泉, 俊雄 and 栗林, 和敏 and 矢沢, 良光}, issue = {10}, journal = {新潟医学会雑誌, 新潟医学会雑誌}, month = {Oct}, note = {In order to evaluate antiplatelet therapy in which platelet aggregation was moderately reduced (to MAR 50-30% by ADP 10μM and to MAR 50-30% by collagen 2μg/ml) in each patient by a combination of aspirin (ASA) and ticlopidine (T), 27 patients with various thrombotic episodes or symptomes were analysed in 6 hospitals near Niigata city. Such moderate inhibition was achieved in 14 patients most often by a combination of ASA 20mg/day and T 200mg/day although the doses were considerably varied among the patients. Reasons and problems prohibiting such platelet function modulation were analysed. These included financial problem for repeated examinations, laboratory capacity, intensive fear of doctors for hemorrhage of especially out patients and poor understanding of doctors of this protocol. No thrombotic episodes were found in all patients during average 7.1 months of observation. Hemorrhagic episodes including bleeding from gastric linear ulcer in a patient occurred, but no severe clinical problems such as cerebral hemorrhage and death were observed. In conclusion, this protocol can be applicable to patients with thrombotic episodes for evaluation of prevention of thrombosis., アスピリン(10mg/日より増量)とチクロピジン(100mg/日より増量)を併用し,症例毎に凝集率をADP 10μM で55-30%, Collagen 2mμg/mlで50-30%に抑える抗血小板療法を6施設の血栓性患者の予防治療に応用し,本療法の応用の問題点,出血の副作用についてまとめた.治療目標域への薬剤のコントロールは27例中14例で達成された.その時の量はアスピリン20mg/日, チクロピジン20mg/日が多かった.達成されなかった理由は症例の薬剤に対する感受性の低下,自覚症状のない患者から協力を得る困難性,検査体制の不備,また主治医の患者の経済負担の増加に対する配慮などがあり,早期の中断の理由には転院,診断名変更,また主治医や外来患者の出血に対する恐れなどがあった.観察期間は平均7.1ケ月で全例に血栓症の発生は見られなかった.出血の副作用は目標域に達した症例では1例の喀血の既往のある慢性気管支拡張症の患者に喀血が見られたが薬剤中止により消失した.目標域に達しない2例に打撲後の紫斑あるいは鼻出血が,また1例で胃潰瘍による消化管出血が見られたが.後者は潰瘍の原因となりうると言われるアスピリンは10mg/日と少量で,本療法が直接の原因とは考え難い.結論として副作用としての出血はあっても軽度で臨床上十分対処出来,本療法は多数の患者に応用可能である.}, pages = {642--649}, title = {血栓予防のためのアスピリン・チクロピジン併用・患者別コントロールによる抗血小板療法の研究 : 第一報 多施設での臨床応用における問題点と出血傾向}, volume = {101}, year = {1987} }