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抗血小板薬と抗凝固薬 ~違いと基本をざっくりと~ | いなかの薬剤師 " /> 循環器
抗血小板薬と抗凝固薬 ~違いと基本をざっくりと~
抗血小板薬と抗凝固薬 の違いと基本について触れる。
今回は本当に基本的なところだけをまとめる(各薬剤の特徴は別にまとめる)
おまけ:バイアスピリンの粉砕
おまけ:プラザキサ®の一包化不可について
① 抗血小板薬と抗凝固薬 のイントとイメージ
血栓形成には「血小板凝集」と「フィブリン凝集」による凝固系が関与している
「血小板凝集」→抗血小板薬
「フィブリン凝集」→抗凝固薬
抗血小板薬
血小板が集まってできる血栓を防ぐために服用する。
(川岸の砂のイメージ:砂が堆積すると川の流れが止まってしまう)
抗凝固薬
血流うっ滞による血栓が出来ないように服用する。
(池の藻のイメージ:藻が集まると流れが悪くなる)
②抗血小板薬(詳細)
血小板凝集に関係しているところに作用し血栓拡大を抑える。
動脈血栓に用いる。
例:
狭心症・心筋梗塞
冠動脈形成術後
非心原性脳梗塞(ラクナ梗塞・アテローム血栓)
場所の認識:
ラクナ梗塞→脳内穿通枝
アテローム血栓→頚動脈~脳内大血管
使用する薬剤例:
アスピリン(バイアスピリン®)
アスピリン/ダイアルミネート配合(バファリン®81mg)
クロピドグレル(プラビックス®)
プラスグレル(エフィエント®)
ジピリダモール(ペルサンチン®)など
おまけ:バイアスピリンの粉砕
・アスピリンは、水分を吸収して「サリチル酸」と「酢酸」に分解される。
『バイアスピリン®』を粉砕した場合、この「酢酸」の匂いや味を感じる。
しかし、分包紙+薬袋に入っていれば薬効に影響はない。
保管状況(25℃・75%RH・1000lux/h)で30日間安定。
・「塩基性のもの」や「金属系」との混合注意(キレート作成して着色)
例えば、ポラプレジンク顆粒(プロマック®顆粒)がNG
(2日後から固化あるいは流動性の低下、機序不明)
また、他の散剤と混合することで(賦形剤含む)湿気を含みやすくなるため
メーカーとしては「別包」推奨
※意外と盲点
「アスピリン末」と「バイアスピリン®」は適応症が
違うため原末を使うときは注意
③凝固薬(詳細)
血栓形成因子であるフィブリンの形成に関係している凝固因子を抑える。
血液うっ帯の状況では、凝固系が一時的に亢進
↓
フィブリンの産生が増大 する
↓
これに血球成分が絡み合って血栓が大きくなる
・静脈血栓・心房に用いる
例:
心房細動→めっちゃ大切
静脈血栓症(深部静脈血栓、肺塞栓症)
使用する薬剤例:
ワルファリンカリウム(ワーファリン®)
新規経口抗凝固薬(DOAC)
リバーロキサバン(イグザレルト®)
アピキサバン(エリキュース®)
エドキサバン(リクシアナ®)
ダビガトランエテキシラート(プラザキサ®)
おまけ:ワーファリン®、プラザキサ®の小ネタ
・化学療法で低たんぱく状態になると
ワーファリン®の効果が増大することがあるので注意
・プラザキサ®は脱カプセルにより血中濃度が上昇する可能性があるため、
粉砕、簡易懸濁は不可。
吸湿性もあるため一包化不可
参考資料
バイエル、ゼリア新薬への問い合わせ