{"id":2704,"date":"2024-08-14T10:15:23","date_gmt":"2024-08-14T01:15:23","guid":{"rendered":"https:\/\/www.hcfm.jp\/journal\/?p=2704"},"modified":"2024-08-14T10:15:23","modified_gmt":"2024-08-14T01:15:23","slug":"%e5%bf%83%e6%88%bf%e7%b4%b0%e5%8b%95%e3%82%92%e3%82%82%e3%81%a4%e3%83%95%e3%83%ac%e3%82%a4%e3%83%ab%e3%81%aa%e9%ab%98%e9%bd%a2%e8%80%85%e3%81%ab%e3%81%8a%e3%81%91%e3%82%8b%e3%80%81vkavitamin-k-antago","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2704","title":{"rendered":"\u5fc3\u623f\u7d30\u52d5\u3092\u3082\u3064\u30d5\u30ec\u30a4\u30eb\u306a\u9ad8\u9f62\u8005\u306b\u304a\u3051\u308b\u3001VKA(vitamin K antagonists)\u304b\u3089NOAC(Non-Vitamin K Antagonist Oral Anticoagulant)\u3078\u306e\u5207\u308a\u66ff\u3048\u306e\u5b89\u5168\u6027\uff1a FRAIL-AF\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u7d50\u679c\u304b\u3089"},"content":{"rendered":"

-\u6587\u732e\u540d-
\nLinda P T Joosten, et al. Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. Circulation. 2024; 149(4): 279-289.<\/p>\n

-\u8981\u7d04-
\n\u25cfIntroduction
\n\u30fbAf\u306b\u5bfe\u3059\u308b\u6297\u51dd\u56fa\u7642\u6cd5\u3092\u65b0\u898f\u306b\u5c0e\u5165\u3059\u308b\u969b\u306f\u3001VKA\u3088\u308a\u3082\u3001\u3053\u308c\u307e\u3067\u306e\u7814\u7a76\u304b\u3089\u51fa\u8840\u30ea\u30b9\u30af\u306e\u5c11\u306a\u3044\u3068\u3055\u308c\u3066\u3044\u308bNOAC\u304c\u9078\u629e\u3055\u308c\u308b\u3053\u3068\u304c\u591a\u3044\u3002
\n\u30fb\u4e00\u65b9\u3067\u3001\u9ad8\u9f62Af\u60a3\u8005\u3067\u306f30-40%\u304cVKA\u3067\u7ba1\u7406\u3055\u308c\u3066\u3044\u308b\u3068\u3055\u308c\u308b\u3002
\n\u30fbVKA\u3067\u7ba1\u7406\u3055\u308c\u3066\u3044\u308b\u5fc3\u623f\u7d30\u52d5\u306e\u30d5\u30ec\u30a4\u30eb\u306a\u60a3\u8005\u306b\u304a\u3044\u3066\u3001NOAC\u306b\u5207\u308a\u66ff\u3048\u308b\u3079\u304d\u304b\u3069\u3046\u304b\u306f\u5b9a\u307e\u3063\u305f\u898b\u89e3\u304c\u306a\u304f\u3001\u3053\u308c\u307e\u3067\u306e\u7814\u7a76\u306f\u89b3\u5bdf\u7814\u7a76\u306b\u3068\u3069\u307e\u3063\u3066\u3044\u305f\u3002<\/p>\n

\u25cfMethod
\n\u30fb\u591a\u65bd\u8a2d\u5171\u540c(\u30aa\u30e9\u30f3\u30c0)\u3001\u975e\u76f2\u691c\u3001pragmatic randomized controlled superiority trial
\n\u30fb\u30d5\u30ec\u30a4\u30eb\u3067\u9ad8\u9f62\u306e(75\u6b73\u4ee5\u4e0a\uff0bGroningen Frailty Indicator\u30b9\u30b3\u30a2\uff0a3\u4ee5\u4e0a)\u5fc3\u623f\u7d30\u52d5\u306e\u60a3\u8005\u3092\u3001INR\u30ac\u30a4\u30c9\u4e0b\u306eVKA\u6cbb\u7642\u304b\u3089NOAC\u6cbb\u7642\u306b\u5207\u308a\u66ff\u3048\u308b\u7fa4(VKA\u4e2d\u6b62\u5f8cINR 1.3\u672a\u6e80\u3068\u306a\u3063\u305f\u3089NOAC\u958b\u59cb\u3002NOAC\u306e\u7a2e\u985e\u306f\u4e3b\u6cbb\u533b\u306e\u88c1\u91cf\u306b\u59d4\u306d\u3089\u308c\u305f)\u3068\uff0cVKA\u6cbb\u7642\u3092\u7d99\u7d9a\u3059\u308b\u7fa4(INR 2.0-3.0\u3067\u7ba1\u7406)\u306b\u7121\u4f5c\u70ba\u306b\u5272\u308a\u4ed8\u3051\u305f\u3002
\n\u30fbGFR 30\u672a\u6e80\u307e\u305f\u306f\u5f01\u819c\u75c7\u6027\u5fc3\u623f\u7d30\u52d5\u306e\u60a3\u8005\u306f\u9664\u5916\u3055\u308c\u305f\u3002
\n\u30fb\u8ffd\u8de1\u671f\u9593\u306f12\u30f5\u6708\u3067\u3042\u3063\u305f(1,3,6,9,12\u304b\u6708\u76ee\u306b\u96fb\u8a71\u306b\u3088\u308b\u30a4\u30f3\u30bf\u30d3\u30e5\u30fc\u3092\u5b9f\u65bd\u3057\u305f)\u3002
\n\u30fb\u6b7b\u4ea1\u3092\u7af6\u5408\u30ea\u30b9\u30af\u3068\u3057\u3066\u8003\u616e\u3057\u3001\u4e3b\u8981\u30a2\u30a6\u30c8\u30ab\u30e0\u3067\u3042\u308b\u5927\u51fa\u8840(\uff0a\u5b9a\u7fa9\uff1a\u81f4\u6b7b\u7684\u51fa\u8840\u3001Hb 2\u4ee5\u4e0a\u306e\u4f4e\u4e0b\u3092\u4f34\u3046\u51fa\u8840\u3001\u8d64\u8840\u7403\u8f38\u88402\u5358\u4f4d\u4ee5\u4e0a\u3092\u8981\u3057\u305f\u51fa\u8840)\u307e\u305f\u306f\u81e8\u5e8a\u7684\u306b\u95a2\u9023\u6027\u306e\u3042\u308b\u975e\u5927\u51fa\u8840\u5408\u4f75\u75c7(\uff0a\u5b9a\u7fa9\uff1a\u6b21\u56de\u53d7\u8a3a\u3092\u65e9\u3081\u308b\u5fc5\u8981\u304c\u3042\u3063\u305f\u51fa\u8840\u3001\u4f55\u3089\u304b\u306e\u533b\u5b66\u7684\u4ecb\u5165\u3092\u8981\u3057\u305f\u51fa\u8840\u3001\u5165\u9662\u3084\u30b1\u30a2\u306e\u30ec\u30d9\u30eb\u3092\u9ad8\u3081\u308b\u5fc5\u8981\u304c\u3042\u3063\u305f\u51fa\u8840)\u306e\u3069\u3061\u3089\u304b\u5148\u306b\u767a\u751f\u3057\u305f\u5834\u5408\u306e\u539f\u56e0\u7279\u7570\u7684\u30cf\u30b6\u30fc\u30c9\u6bd4\u3092\u7b97\u51fa\u3057\u305f\u3002
\n\u30fb\u89e3\u6790\u306fintention-to-treat\u306e\u539f\u5247\u306b\u5f93\u3063\u305f\u3002
\n\u30fb\u526f\u6b21\u7684\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u306f\u8840\u6813\u585e\u6813\u75c7\u306e\u30a4\u30d9\u30f3\u30c8\u304c\u542b\u307e\u308c\u305f\u3002<\/p>\n

\uff0a\u8a33\u8005\u6ce8\uff1aGroningen Frailty Indicator\u3068\u306f\uff1a\u65e5\u5e38\u6d3b\u52d5\uff08\u8cb7\u3044\u7269\u3001\u5916\u51fa\u3001\u66f4\u8863\u3001\u30c8\u30a4\u30ec\u79fb\u52d5\uff09\u3001\u5065\u5eb7\u554f\u984c\uff08\u8eab\u4f53\u7684\u5065\u5eb7\u3001\u8996\u529b\u3001\u8074\u529b\u3001\u4f53\u91cd\u6e1b\u5c11\u30014\u5264\u4ee5\u4e0a\u306e\u670d\u85ac\u3001\u8a18\u61b6\uff09\u3001\u5fc3\u7406\u6a5f\u80fd\uff08\u7a7a\u865a\u611f\u3001\u5b64\u72ec\u3001\u898b\u6368\u3066\u3089\u308c\u611f\u3001\u843d\u80c6\u3001\u4e0d\u5b89\uff09\u3068\u3044\u3063\u305f3\u30c9\u30e1\u30a4\u30f3\u300115\u9805\u76ee\u3092\u691c\u8a0e\u3057\u30014\u9805\u76ee\u4ee5\u4e0a\u554f\u984c\u3092\u62b1\u3048\u308b\u5834\u5408\u3001\u30d5\u30ec\u30a4\u30eb\u3068\u5224\u5b9a\u3059\u308b\u3002(\u53c2\u7167\uff1a\u516c\u76ca\u8ca1\u56e3\u6cd5\u4eba\u9577\u5bff\u79d1\u5b66\u632f\u8208\u8ca1\u56e3\u300e\u7dcf\u8ad6 \u30d5\u30ec\u30a4\u30eb\u306e\u5168\u4f53\u50cf\u3092\u5b66\u3076 2. \u30d5\u30ec\u30a4\u30eb\u306e\u8a55\u4fa1\u65b9\u6cd5\u3068\u6700\u65b0\u75ab\u5b66\u7814\u7a76\u300f(https:\/\/www.tyojyu.or.jp\/kankoubutsu\/gyoseki\/frailty-yobo-taisaku\/R2-2-2.html) 2024\/7\/16\u95b2\u89a7)<\/p>\n

Supplement S1 (Supplemental Material\u306e\u3046\u3061\u3001\u4e00\u756a\u4e0a\u306epdf\u30d5\u30a1\u30a4\u30eb\u5185)
\nhttps:\/\/www.ahajournals.org\/doi\/suppl\/10.1161\/CIRCULATIONAHA.123.066485
\n\"\"<\/a>
\n\u25cfResults
\n<\u6982\u8981>
\n\u30fb2018\u5e741\u6708\u304b\u30892022\u5e746\u6708\u306e\u9593\u306b\u5b9f\u65bd
\n\u30fb\u5408\u8a082621\u4f8b\u306e\u60a3\u8005\u304c\u9069\u683c\u6027\u3092\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3055\u308c\u30011330\u4f8b\u304c\u7121\u4f5c\u70ba\u306b\u5272\u308a\u4ed8\u3051\u3089\u308c\u305f\uff08\u5e73\u5747\u5e74\u9f6283\u6b73\u3001Groningen Frailty Indicator\u30b9\u30b3\u30a2\u4e2d\u592e\u50244\u3002\u9664\u5916\u60a3\u8005\u306f\u3001\u30d5\u30ec\u30a4\u30eb\u306e\u57fa\u6e96\u3092\u6e80\u305f\u3055\u306a\u304b\u3063\u305f\u3082\u306e\u304c\u5927\u534a\uff09\u3002
\n\u30fb\u7121\u4f5c\u70ba\u5316\u5f8c\u3001\u9664\u5916\u57fa\u6e96\u306e\u5b58\u5728\u306b\u3088\u308aVKA\u2192NOAC\u7fa4\u306e6\u4f8b\u3068VKA\u7d99\u7d9a\u7fa4\u306e1\u4f8b\u304c\u9664\u5916\u3055\u308c\u3001intention-to-treat\u96c6\u56e3\u3067\u306fVKA\u304b\u3089NOAC\u306b\u5909\u66f4\u3057\u305f662\u4f8b\u3068VKA\u3092\u7d99\u7d9a\u3057\u305f661\u4f8b\u304c\u6b8b\u3063\u305f\u3002<\/p>\n

(\u5404\u7fa4\u306e\u7279\u5fb4)
\n\"\"<\/a>
\n-\u51fa\u8840\u30ea\u30b9\u30af\u306e\u30b9\u30b3\u30a2\u3067\u3042\u308b\u3001CHA2DS2VASc\u30b9\u30b3\u30a2\u306f\u5404\u7fa4\u3067\u540c\u7b49\u3060\u3063\u305f\u3002<\/p>\n

\u30fb163\u4f8b\u306e\u4e3b\u8981\u8ee2\u5e30\u30a4\u30d9\u30f3\u30c8\uff08\u5207\u308a\u66ff\u3048\u7fa4101\u4f8b\u3001\u7d99\u7d9a\u7fa462\u4f8b\uff09\u306e\u5f8c\u3001\u4e8b\u524d\u306b\u898f\u5b9a\u3057\u305f\u7121\u76ca\u6027\u89e3\u6790\u306b\u3088\u308a\u8a66\u9a13\u306f\u7121\u76ca\u306e\u305f\u3081\u4e2d\u6b62\u3055\u308c\u305f\u3002
\n\u30fb\u4e3b\u8981\u8ee2\u5e30\u306e\u30cf\u30b6\u30fc\u30c9\u6bd4\u306f1.69\uff0895\uff05CI\u30011.23-2.32\uff09\u3067\u3042\u3063\u305f\u3002\u8840\u6813\u585e\u6813\u30a4\u30d9\u30f3\u30c8\u306e\u30cf\u30b6\u30fc\u30c9\u6bd4\u306f1.26\uff0895\uff05CI\u30010.60-2.61\uff09\u3067\u3042\u3063\u305f\u3002<\/p>\n

(primary, secondary outcome\u306e\u7d50\u679c\u306e\u307e\u3068\u3081)
\n\"\"<\/a>
\n(\u6700\u521d\u306e\u51fa\u8840\u307e\u3067\u306e\u3001\u5404\u7fa4\u306ecumulative incidence curve)\"\"<\/a>
\n(\u30b5\u30d6\u30b0\u30eb\u30fc\u30d7\u89e3\u6790)\"\"<\/a>-NOAC\u306e\u7a2e\u985e\u306b\u3088\u308aHR\u306b\u9055\u3044\u306f\u307f\u3089\u308c\u308b\u3082\u306e\u306f\u3042\u308b\u304c\u3001post hoc\u3067\u975e\u30e9\u30f3\u30c0\u30e0\u5316\u89e3\u6790\u306e\u305f\u3081\u89e3\u91c8\u306b\u306f\u6ce8\u610f\u304c\u5fc5\u8981\u3002<\/p>\n

<\u7d50\u8ad6>
\n\u5fc3\u623f\u7d30\u52d5\u3092\u6709\u3059\u308b\u30d5\u30ec\u30a4\u30eb\u306a\u9ad8\u9f62\u60a3\u8005\u306b\u304a\u3044\u3066\u3001INR\u30ac\u30a4\u30c9\u4e0b\u306eVKA\u6cbb\u7642\u304b\u3089NOAC\u6cbb\u7642\u306b\u5207\u308a\u66ff\u3048\u308b\u3053\u3068\u306f\u3001VKA\u6cbb\u7642\u3092\u7d99\u7d9a\u3059\u308b\u3053\u3068\u3068\u6bd4\u8f03\u3057\u3066\u51fa\u8840\u6027\u5408\u4f75\u75c7\u306e\u5897\u52a0\u3068\u95a2\u9023\u3057\u305f\u304c\u3001\u8840\u6813\u585e\u6813\u6027\u5408\u4f75\u75c7\u306e\u6e1b\u5c11\u306f\u95a2\u9023\u3057\u306a\u304b\u3063\u305f\u3002<\/p>\n

\u25cfDiscussion
\n\u30fb\u30aa\u30e9\u30f3\u30c0\u3067\u306fPT-INR\u306b\u3088\u308b\u30d3\u30bf\u30df\u30f3K\u62ee\u6297\u85ac\u306e\u7528\u91cf\u7ba1\u7406\u306e\u8cea\u304c\u9ad8\u304f\u3001Federatie van Nederlandse Trombosediensten\uff08\u30aa\u30e9\u30f3\u30c0\u8840\u6813\u75c7\u30b5\u30fc\u30d3\u30b9\u9023\u76df\uff09\u306e\u5e74\u6b21\u5831\u544a\u66f8\u306b\u3088\u308c\u3070\uff0cINR \u306e\u81f3\u9069\u7bc4\u56f2\u5185\u6642\u9593\uff08TTR\uff09\u306f65.3\uff5e74.0\uff05\u3067\u3042\u308b\u3002
\n\u2192INR\u30ac\u30a4\u30c9\u4e0bVKA\u7ba1\u7406\u3067\u5b89\u5b9a\u3057\u3066\u3044\u308b\uff08TTR\u224870%\uff09\u60a3\u8005\u3092NOAC\u306b\u5207\u308a\u66ff\u3048\u308b\u304b\u3069\u3046\u304b\u306f\u3001\u5927\u51fa\u8840\u307e\u305f\u306f\u81e8\u5e8a\u7684\u306b\u95a2\u9023\u6027\u306e\u3042\u308b\u975e\u5927\u51fa\u8840\u306e\u30ea\u30b9\u30af\u304c\u9ad8\u307e\u308b\u3068\u3044\u3046\u672c\u8ad6\u6587\u306e\u7d50\u679c\u304b\u3089\u3001\u614e\u91cd\u306b\u691c\u8a0e\u3059\u3079\u304d\u3067\u3042\u308b\u3002(\u672c\u6587\u306b\u8a18\u8f09\u3042\u308a)
\n\u2192\u4e00\u65b9\u3067\u3001TTR \u304c\u4f4e\u3044\u60a3\u8005\u3067\u306f\u3001\u72b6\u6cc1\u306b\u5fdc\u3058\u3066DOAC \u3078\u306e\u5207\u308a\u66ff\u3048\u304c\u8a31\u5bb9\u3067\u304d\u308b\u4f8b\u304c\u5b58\u5728\u3059\u308b\u53ef\u80fd\u6027\u306f\u3042\u308b\u3068\u601d\u3046\u3002(\u8a33\u8005\u304c\u8a18\u8f09)<\/p>\n

\u30fbNOAC\u306e\u9078\u629e\u306f\u6cbb\u7642\u533b\u306e\u88c1\u91cf\u306b\u4efb\u3055\u308c\u3066\u3044\u305f\u70b9\u306f\u3001\u7d50\u679c\u306b\u5f71\u97ff\u3057\u305f\u53ef\u80fd\u6027\u306f\u3042\u308b\u3002\u89b3\u5bdf\u7814\u7a76\u3067\u306f\u3001\u30ea\u30d0\u30fc\u30ed\u30ad\u30b5\u30d0\u30f3\uff08\u672c\u8a66\u9a13\u3067\u6700\u3082\u51e6\u65b9\u3055\u308c\u305fNOAC\uff09\u306f\u4ed6\u306eNOAC\u3088\u308a\u3082\u51fa\u8840\u6027\u5408\u4f75\u75c7\u304c\u591a\u304f\u3001\u7279\u306b\u6d88\u5316\u7ba1\u51fa\u8840\u304c\u591a\u304f\u3001\u9ad8\u9f62\u8005\u3067\u306f\u30a2\u30d4\u30ad\u30b5\u30d0\u30f3\u306e\u5b89\u5168\u6027\u30d7\u30ed\u30d5\u30a1\u30a4\u30eb\u304c\u6700\u3082\u512a\u308c\u3066\u3044\u308b\u3002\u3068\u306f\u3044\u3048\u3001\u51e6\u65b9\u3055\u308c\u305fNOAC\u306e\u7a2e\u985e\u306f\u975e\u30e9\u30f3\u30c0\u30e0\u5316\u3067\u3042\u3063\u305f\u305f\u3081\u3001\u3053\u306e\u30d5\u30ec\u30a4\u30eb\u306a\u96c6\u56e3\u306b\u304a\u3044\u3066\u4e00\u65b9\u306eNOAC\u304c\u4ed6\u65b9\u306eNOAC\u3088\u308a\u3082\u512a\u5148\u3055\u308c\u308b\u3079\u304d\u304b\u3069\u3046\u304b\u306b\u3064\u3044\u3066\u306f\u3001\u672c\u8a66\u9a13\u3067\u306f\u7b54\u3048\u308b\u3053\u3068\u304c\u3067\u304d\u306a\u3044\u3002<\/p>\n

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\u3010\u958b\u50ac\u65e5\u30112024\u5e748\u670814\u65e5<\/p>\n","protected":false},"excerpt":{"rendered":"

-\u6587\u732e\u540d- Linda P T Joosten, et al. Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist … \u7d9a\u304d\u3092\u8aad\u3080 \u5fc3\u623f\u7d30\u52d5\u3092\u3082\u3064\u30d5\u30ec\u30a4\u30eb\u306a\u9ad8\u9f62\u8005\u306b\u304a\u3051\u308b\u3001VKA(vitamin K antagonists)\u304b\u3089NOAC(Non-Vitamin K Antagonist Oral Anticoagulant)\u3078\u306e\u5207\u308a\u66ff\u3048\u306e\u5b89\u5168\u6027\uff1a FRAIL-AF\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u7d50\u679c\u304b\u3089<\/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":[23,11],"tags":[],"class_list":["post-2704","post","type-post","status-publish","format-standard","hentry","category-23","category-11"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2704","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=2704"}],"version-history":[{"count":2,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2704\/revisions"}],"predecessor-version":[{"id":2711,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2704\/revisions\/2711"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2704"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2704"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2704"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}