{"id":2075,"date":"2020-12-25T10:16:12","date_gmt":"2020-12-25T01:16:12","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=2075"},"modified":"2020-12-25T10:16:12","modified_gmt":"2020-12-25T01:16:12","slug":"%e8%b6%85%e9%ab%98%e9%bd%a2%e5%bf%83%e6%88%bf%e7%b4%b0%e5%8b%95%e6%82%a3%e8%80%85%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e4%bd%8e%e7%94%a8%e9%87%8f%e3%82%a8%e3%83%89%e3%82%ad%e3%82%b5%e3%83%90%e3%83%b3","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2075","title":{"rendered":"\u8d85\u9ad8\u9f62\u5fc3\u623f\u7d30\u52d5\u60a3\u8005\u306b\u5bfe\u3059\u308b\u4f4e\u7528\u91cf\u30a8\u30c9\u30ad\u30b5\u30d0\u30f3"},"content":{"rendered":"

\uff0d\u6587\u732e\u540d\uff0d
\nK.Okumura. Low-Dose Edoxaban in Very Elderly Patients with Atrial Fibrillation. NEJM. 2020; Oct 29; 383(18): 1735-1745.<\/p>\n

\uff0d\u8981\u7d04\uff0d
\nIntroduction\uff1a
\n\u5e74\u9f62\u3068\u3068\u3082\u306b\u5fc3\u623f\u7d30\u52d5\u306f\u5897\u52a0\u3057\u3001\u5e74\u9f62\u3068\u5fc3\u623f\u7d30\u52d5\u306f\u3044\u305a\u308c\u3082\u8133\u6897\u585e\u306e\u30ea\u30b9\u30af\u3067\u3042\u308b\u3002\u5fc3\u623f\u7d30\u52d5\u60a3\u8005\u306e\u8133\u6897\u585e\u4e88\u9632\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3067\u306f\u3001\u9ad8\u9f62\u8005\u3067\u3042\u3063\u3066\u3082\u6297\u51dd\u56fa\u7642\u6cd5\u304c\u63a8\u5968\u3055\u308c\u308b\u304c\u3001\u8d85\u9ad8\u9f62\u8005\u306b\u306f\u814e\u6a5f\u80fd\u969c\u5bb3\u30fb\u904e\u53bb\u306e\u51fa\u8840\u6b74\u30fb\u904e\u53bb\u306e\u8ee2\u5012\u6b74\u30fb\u30dd\u30ea\u30d5\u30a1\u30fc\u30de\u30b7\u30fc\u30fb\u30d5\u30ec\u30a4\u30eb\u306a\u3069\u306e\u51fa\u8840\u30ea\u30b9\u30af\u3092\u9451\u307f\u3066\u3001\u51e6\u65b9\u3092\u305f\u3081\u3089\u3046\u533b\u5e2b\u304c\u591a\u3044\u3002\u9ad8\u9f62\u5316\u306b\u4f34\u3044\u3001\u30cf\u30a4\u30ea\u30b9\u30af\u30fb\u8d85\u9ad8\u9f62\u8005\u306e\u6297\u51dd\u56fa\u7642\u6cd5\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u304c\u5fc5\u8981\u3067\u3042\u308b\u3002
\n\u3000\u4f4e\u7528\u91cf\u30a8\u30c9\u30ad\u30b5\u30d0\u30f3\uff0815-30mg\uff09\u306f\u8133\u6897\u585e\u4e88\u9632\u306b\u306f\u7528\u91cf\u4e0d\u8db3\u3068\u3057\u3066\u8a8d\u53ef\u5916\u3067\u306f\u3042\u308b\u304c\u3001\u51fa\u8840\u306e\u30cf\u30a4\u30ea\u30b9\u30af\u7fa4\u3067\u3042\u308b\u8d85\u9ad8\u9f62\u8005\u306b\u3068\u3063\u3066\u306f\u6709\u76ca\u3067\u3042\u308b\u304b\u3082\u3057\u308c\u306a\u3044\u3002
\nMethod\uff1a
\n\u3000\u4eca\u56de\u306eELDERCARE-AF\u8a66\u9a13\u306f\u3001\u975e\u5f01\u819c\u75c7\u6027\u5fc3\u623f\u7d30\u52d5\u3092\u6709\u3057\u3001\u8133\u5352\u4e2d\u4e88\u9632\u306b\u627f\u8a8d\u3055\u308c\u3066\u3044\u308b\u7528\u91cf\u3067\u306e\u7d4c\u53e3\u6297\u51dd\u56fa\u7642\u6cd5\u304c\u9069\u5f53\u3067\u306f\u306a\u3044\u3068\u5224\u65ad\u3055\u308c\u305f\u8d85\u9ad8\u9f62\uff0880 \u6b73\u4ee5\u4e0a\uff09\u306e\u65e5\u672c\u4eba\u60a3\u8005\u3092\u5bfe\u8c61\u306b\u3001\u30a8\u30c9\u30ad\u30b5\u30d0\u30f315mg\u306e1\u65e51\u56de\u6295\u4e0e\u3068\u30d7\u30e9\u30bb\u30dc\u6295\u4e0e\u3068\u3092\u6bd4\u8f03\u3059\u308b\u7b2c3\u76f8\u591a\u65bd\u8a2d\u5171\u540c\u7121\u4f5c\u70ba\u5316\u4e8c\u91cd\u76f2\u691c\u30d7\u30e9\u30bb\u30dc\u5bfe\u7167\u30a4\u30d9\u30f3\u30c8\u4e3b\u5c0e\u578b\u8a66\u9a13\uff08\u4e3b\u8981\u8a55\u4fa1\u9805\u76ee\u306e\u767a\u73fe\u304c\u5b9a\u3081\u3089\u308c\u305f\u5b9a\u6570\u306b\u9054\u3059\u308b\u307e\u3067\u7d99\u7d9a\u3059\u308b\u8a66\u9a13\uff09\u3067\u3042\u308b\u3002COI\u3068\u3057\u3066\u7b2c\u4e00\u4e09\u5171\u304b\u3089\u306e\u8cc7\u91d1\u63d0\u4f9b\u3042\u308a\u3002
\nPatient\uff1a80\u6b73\u4ee5\u4e0a\u306e\u975e\u5f01\u819c\u75c7\u6027\u5fc3\u623f\u7d30\u52d5\u3092\u6709\u3057\u3001CHADs2\u30b9\u30b3\u30a2\u306f\uff12\u70b9\u4ee5\u4e0a\u3002CCr15-30\u3001\u51fa\u8840\u306e\u65e2\u5f80\u3001BW45kg\u4ee5\u4e0b\u3001NSAIDs\u5185\u670d\u4e2d\u3001\u6297\u8840\u5c0f\u677f\u85ac\u5185\u670d\u3068\u3044\u3063\u305f\u7406\u7531\u304b\u3089\u6297\u51dd\u56fa\u7642\u6cd5\u3092\u898b\u9001\u3089\u308c\u3066\u3044\u308b\u3002
\nIntervention\uff1a\u30a8\u30c9\u30ad\u30b5\u30d0\u30f315mg\u5185\u670d
\nComparison\uff1a\u30d7\u30e9\u30bb\u30dc
\nOutcome\uff1a4-48\u9031\u76ee\u307e\u3067\u306f4\u9031\u6bce\u3001\u4ee5\u964d\u306f8\u9031\u6bce\u306b\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\u3092\u884c\u3044\u3001\u6709\u52b9\u6027\u3068\u3057\u3066\u8133\u5352\u4e2d\u307e\u305f\u306f\u5168\u8eab\u6027\u585e\u6813\u75c7\u306e\u767a\u75c7\u3001\u5b89\u5168\u6027\u3068\u3057\u3066\u56fd\u969b\u8840\u6813\u6b62\u8840\u5b66\u4f1a\uff08ISTH\uff09\u306e\u5b9a\u7fa9\u306b\u3088\u308b\u5927\u51fa\u8840\u306e\u767a\u75c7\u3092\u8a55\u4fa1\u3057\u305f\u3002
\nResults\uff1a
\n2016\u5e748\u6708\u301c2019\u5e7411\u6708\u306b164\u306e\u65bd\u8a2d\u30011086\u540d\u304c\u30a8\u30f3\u30c8\u30ea\u30fc\u3057\u3001984\u540d\u304c\u30a8\u30c9\u30ad\u30b5\u30d0\u30f315 mg\/\u65e5\u306e\u6295\u4e0e\u3092\u53d7\u3051\u308b\u7fa4\uff08492\u4f8b\uff09\u3068\u30d7\u30e9\u30bb\u30dc\u6295\u4e0e\u3092\u53d7\u3051\u308b\u7fa4\uff08492\u4f8b\uff09\u306b1:1\u306e\u5272\u5408\u3067\u7121\u4f5c\u70ba\u306b\u5272\u308a\u4ed8\u3051\u3089\u308c\u305f\u3002\u9664\u5916\u3055\u308c\u305f102\u540d\u306f20\u540d\u304c\u540c\u610f\u64a4\u56de\u30013\u540d\u304c\u6b7b\u4ea1\u300179\u4f8b\u304c\u57fa\u6e96\u3092\u6e80\u305f\u3055\u306a\u304b\u3063\u305f\u3002\u5e73\u5747\u5e74\u9f62\u306f86.6\uff08\u00b14.2\uff09\u6b73\u3001\u5e73\u5747\u4f53\u91cd\u306f50.6\uff08\u00b111.0\uff09kg\u3001\u5e73\u5747CCr36.3\uff08\u00b114.4\uff09\u3067\u3042\u3063\u305f\u3002423\u540d\u304c\u904e\u53bb\u306b\u6297\u51dd\u56fa\u7642\u3092\u53d7\u3051\u3066\u3044\u305f\u3002\u8ffd\u8de1\u671f\u9593\u306f\u5e73\u5747466\u65e5\u3067\u3001681\u4f8b\u304c\u8a66\u9a13\u3092\u5b8c\u4e86\u3001303 \u4f8b\u304c\u4e2d\u6b62\u3068\u306a\u3063\u305f\u3002\uff08\u540c\u610f\u306e\u64a4\u56de158\u4f8b\u30fb\u6b7b\u4ea1135\u4f8b\u30fb\u305d\u306e\u4ed6\u306e\u7406\u753110\u4f8b\uff09\u8a66\u9a13\u3092\u4e2d\u6b62\u3057\u305f\u4e3b\u306a\u7406\u7531\u306f\u51fa\u8840\u3068\u95a2\u4fc2\u306e\u306a\u3044\u6709\u5bb3\u4e8b\u8c61\u3068\u8a66\u9a13\u7d99\u7d9a\u306e\u610f\u5fd7\u55aa\u5931\u30fb\u80fd\u529b\u6b20\u5982\u3067\u3042\u308a\u3001\u4eba\u6570\u306f2\u7fa4\u3067\u540c\u7a0b\u5ea6\u3067\u3042\u3063\u305f\u3002
\n66\u4f8b\u306e\u8133\u5352\u4e2d\u307e\u305f\u306f\u5168\u8eab\u6027\u585e\u6813\u75c7\u304b\u308959\u4f8b\u304c\u4e3b\u8981\u6709\u52b9\u6027\u8a55\u4fa1\u9805\u76ee\u3068\u3057\u3066\u8a8d\u5b9a\u3055\u308c\u3001\u30a8\u30c9\u30ad\u30b5\u30d0\u30f3\u7fa4\u306715\u4f8b\uff082.3%\/\u4eba\u5e74\u3001\u30d7\u30e9\u30bb\u30dc\u7fa4\u306744\u4f8b\uff086.7%\/\u4eba\u5e74\uff09\u3067\u3042\u3063\u305f\u3002\uff08\u30cf\u30b6\u30fc\u30c9\u6bd40.34, 95%CI 0.19\uff5e0.61, P\uff1c0.001\uff09\u30b5\u30d6\u30b0\u30eb\u30fc\u30d7\u89e3\u6790\u3067\u3082\u6982\u306d\u540c\u69d8\u306e\u7d50\u679c\u3067\u3042\u3063\u305f\u304c\u3001NSAIDs\u5185\u670d\u7fa4\u306e\u307f\u7d50\u679c\u306e\u3070\u3089\u3064\u304d\u304c\u3042\u3063\u305f\u3002
\n\u5b89\u5168\u6027\u306e\u8a55\u4fa1\u3068\u3057\u3066\u306f\u300122\u4f8b\u306e\u5927\u51fa\u8840\u30a4\u30d9\u30f3\u30c8\u304c\u3042\u308a\u3001\u30a8\u30c9\u30ad\u30b5\u30d0\u30f3\u7fa4\u306720\u4f8b\uff083.3%\/\u4eba\u5e74\uff09\u3001\u30d7\u30e9\u30bb\u30dc\u7fa4\u3067\uff111\u4f8b\uff081.8%\/\u4eba\u5e74\uff09\u3067\u3042\u3063\u305f\u3002\uff08\u30cf\u30b6\u30fc\u30c9\u6bd41.87, 95%CI 0.90\uff5e3.89\uff0cP\uff1d0.09\uff09\u6d88\u5316\u7ba1\u51fa\u8840\u306b\u9650\u308b\u3068\u3001\u30a4\u30d9\u30f3\u30c8\u767a\u751f\u6570\u306f\u30a8\u30c9\u30ad\u30b5\u30d0\u30f3\u7fa4\u306e\u307b\u3046\u304c\u30d7\u30e9\u30bb\u30dc\u7fa4\u3088\u308a\u3082\u591a\u3044\u7d50\u679c\u3068\u306a\u3063\u305f\u3002\u5168\u6b7b\u56e0\u6b7b\u4ea1\u306b\u5927\u304d\u306a\u7fa4\u9593\u5dee\u306f\u306a\u304b\u3063\u305f\u3002\uff08\u30a8\u30c9\u30ad\u30b5\u30d0\u30f3\u7fa49.9%, \u30d7\u30e9\u30bb\u30dc\u7fa410.2%\uff0c\u30cf\u30b6\u30fc\u30c9\u6bd40.97\uff0c95%CI 0.69\uff5e1.36\uff09
\nDiscussion\uff1a
\n\u3000\u672c\u8a66\u9a13\u306fENGAGE AF-TIMI48\u8a66\u9a13\u306e\u30c7\u30fc\u30bf\u3092\u3082\u3068\u306b\u30a8\u30c9\u30ad\u30b5\u30d0\u30f3\u309215mg\u306b\u6e1b\u91cf\u3057\u3066\u4f7f\u7528\u3057\u305f\u3002
\n\u8133\u5352\u4e2d\u3068\u51fa\u8840\u306e\u4e21\u65b9\u306e\u30ea\u30b9\u30af\u304c\u9ad8\u3044\u8d85\u9ad8\u9f62\u8005\u306b\u5bfe\u3059\u308b\u78ba\u7acb\u3055\u308c\u305f\u6a19\u6e96\u6cbb\u7642\u306f\u306a\u304f\u3001\u5bfe\u7167\u3068\u3057\u3066\u30d7\u30e9\u30bb\u30dc\u3092\u4f7f\u7528\u3057\u305f\u3002\u5148\u884c\u7814\u7a76\u3067\u306f\u30a2\u30b9\u30d4\u30ea\u30f3\u306f\u5fc3\u623f\u7d30\u52d5\u306e\u60a3\u8005\u306e\u8133\u5352\u4e2d\u306e\u4e88\u9632\u306b\u52b9\u679c\u304c\u306a\u304f\u3001\u8133\u5352\u4e2d\u306e\u30ea\u30b9\u30af\u304c\u9ad8\u3044\u60a3\u8005\u306b\u306f\u63a8\u5968\u3055\u308c\u306a\u304b\u3063\u305f\u305f\u3081\u3001\u6bd4\u8f03\u5bfe\u7167\u85ac\u3068\u3057\u3066\u6297\u8840\u5c0f\u677f\u85ac\u3092\u4f7f\u7528\u3057\u306a\u304b\u3063\u305f\u3002
\n\u5148\u884c\u7814\u7a76\u3067\u814e\u6a5f\u80fd\u969c\u5bb3\u304c\u3042\u308a(CCr15-30)\u30a8\u30c9\u30ad\u30b5\u30d0\u30f315mg\u3092\u6295\u4e0e\u3055\u308c\u305f\u4eba\u3068\u3001\u814e\u6a5f\u80fd\u969c\u5bb3\u304c\u306a\u304f\u30a8\u30c9\u30ad\u30b5\u30d0\u30f330-60mg\u3092\u6295\u4e0e\u3055\u308c\u305f\u4eba\u306e\u8840\u4e2d\u6fc3\u5ea6\u306f\u985e\u4f3c\u3057\u3066\u304a\u308a\u3001\u4eca\u56de\u306e\u8a66\u9a13\u3068\u5148\u884c\u7814\u7a76\u3067\u306e\u6709\u52b9\u6027\u30fb\u5b89\u5168\u6027\u306e\u7d50\u679c\u304c\u540c\u69d8\u3067\u3042\u3063\u305f\u4e00\u56e0\u304b\u3082\u3057\u308c\u306a\u3044\u3002
\nLimitation\uff1a
\n\u3000\u8131\u843d\u60a3\u8005\u304c\u591a\u304b\u3063\u305f\u304c\u3001\u51fa\u8840\u306b\u95a2\u9023\u3057\u305f\u540c\u610f\u53d6\u308a\u4e0b\u3052\u306f6\u540d\u306e\u307f\u3067\u3042\u308a\u3001\u591a\u304f\u306f\u51fa\u8840\u3068\u306f\u95a2\u4fc2\u306e\u306a\u3044\u6709\u5bb3\u4e8b\u8c61\u304c\u7406\u7531\u3068\u306a\u3063\u305f\u3002
\n\u3000\u65e5\u672c\u4eba\uff08\u6771\u30a2\u30b8\u30a2\u4eba\uff09\u306f\u4ed6\u306e\u4eba\u7a2e\u3068\u6bd4\u8f03\u3057\u3066\u8133\u5352\u4e2d\u3084\u5168\u8eab\u6027\u8840\u6813\u75c7\u306e\u767a\u751f\u7387\u304c\u9ad8\u304f\u3001\u51fa\u8840\u306e\u767a\u751f\u7387\u3082\u9ad8\u3044\u305f\u3081\u3001\u4ed6\u306e\u96c6\u56e3\u3067\u9069\u5fdc\u3067\u304d\u306a\u3044\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002<\/p>\n

\"JC2020\u4f50\u91ce\uff11\"<\/a><\/p>\n

\"JC2020\u4f50\u91ce\uff12\"<\/a><\/p>\n

\"JC2020\u4f50\u91ce\uff13\"<\/a><\/p>\n

\"JC2020\u4f50\u91ce\uff14\"<\/a><\/p>\n

\"JC2020\u4f50\u91ce\uff15\"<\/a><\/p>\n

\"JC2020\u4f50\u91ce\uff16\"<\/a><\/p>\n

\u3010\u958b\u50ac\u65e5\u30112020\u5e7412\u67089\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\uff0d\u6587\u732e\u540d\uff0d K.Okumura. Low-Dose Edoxaban in Very Elderly Patients with Atrial Fibrillation. NEJM. 2020; Oct 29; 383( … \u7d9a\u304d\u3092\u8aad\u3080 \u8d85\u9ad8\u9f62\u5fc3\u623f\u7d30\u52d5\u60a3\u8005\u306b\u5bfe\u3059\u308b\u4f4e\u7528\u91cf\u30a8\u30c9\u30ad\u30b5\u30d0\u30f3<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17,11],"tags":[],"class_list":["post-2075","post","type-post","status-publish","format-standard","hentry","category-17","category-11"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2075","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2075"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2075\/revisions"}],"predecessor-version":[{"id":2082,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2075\/revisions\/2082"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2075"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2075"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2075"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}