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Risk Stratification of Cerebral Bleeding during Antithrombotic Therapy

Research Project

Project/Area Number 16K09468
Research Category

Grant-in-Aid for Scientific Research (C)

Allocation TypeMulti-year Fund
Section一般
Research Field Cardiovascular medicine
Research InstitutionKurume University

Principal Investigator

Kai Hisashi  久留米大学, その他部局等, 教授 (60281531)

Co-Investigator(Kenkyū-buntansha) 姉川 敬裕  久留米大学, 医学部, 助教 (00511833)
福田 賢治  久留米大学, 医学部, 講師 (10624512)
岩元 美子  久留米大学, 医学部, 助教 (30597422)
打和 大幹  久留米大学, 医学部, 助教 (30624506)
Project Period (FY) 2016-04-01 – 2019-03-31
Project Status Completed (Fiscal Year 2018)
Budget Amount *help
¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000)
Fiscal Year 2018: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
Fiscal Year 2017: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
Fiscal Year 2016: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
Keywords内科系臨床医学・臨床心臓学 / 冠動脈疾患 / 抗血小板薬 / 抗凝固薬 / 抗血栓療法 / 危険因子 / 頭蓋内微小出血 / 頭部MRI / 頭蓋内出血 / MRI / リスク層別化
Outline of Final Research Achievements

In this prospective observational study, we sought to investigate whether dual antiplatelet therapy (DAPT) and the combination therapy with antiplatelet and oral anticoagulant drugs would increase cerebral microbleeds (CMBs) detected on brain MRI T2* imaging and then increase intracranial hemorrhage in patients with cardiovascular disease. Our preliminary results showed that among 14 DAPT patients with coronary artery disease, 14% had CMBs at the baseline study. After 12 months, another 14% had new CMBs. At the baseline coronary angiography, the CMBs-positive patients had greater number of coronary lesions and a trend of higher SYTAX score, compared with CMBs-negative patients. Systolic blood pressure (SBP) at the baseline was similar between CMBs-positive and CMBs-negative patients. After 8-month follow-up, SBP was higher in CMBs-positive patients than in CMBs-negative ones.

Academic Significance and Societal Importance of the Research Achievements

本研究は、CMBsが抗血栓療法中の頭蓋内出血リスクを回避するための個別的診療・リスク層別化の客観的指標となりうる。これまで抗血栓薬の有無にかかわらず、国内外を問わず心血管疾患患者におけるCMBsの頻度や予後に関する前向き検討はみられないことから本研究の学術性意義は高い。
MBsにより、心血管疾患患者における抗血栓療法中の頭蓋内出血発症リスク層別化が可能となることから、抗血栓療法をうける心血管疾患患者における頭蓋内出血が減少し、患者の生命予後およびQOL改善に繋がる。頭蓋内出血による寝たきり増加を予防することで、増加し続けるわが国の医療費・介護費の削減にも貢献できるため、社会的意義も大きい。

Report

(4 results)
  • 2018 Annual Research Report   Final Research Report ( PDF )
  • 2017 Research-status Report
  • 2016 Research-status Report
  • Research Products

    (27 results)

All 2019 2018 2017 2016

All Journal Article (12 results) (of which Peer Reviewed: 10 results,  Open Access: 2 results) Presentation (15 results) (of which Int'l Joint Research: 8 results,  Invited: 1 results)

  • [Journal Article] Effects of blood pressure lowering in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis2019

    • Author(s)
      Kawano H、Fujiwara A、Kai H、Kumagai E、Okamoto R、Shibata R、Ohtsubo T、Tamura K、Maemura K、Hisatomi A
    • Journal Title

      Hypertension Research

      Volume: 42 Issue: 4 Pages: 504-513

    • DOI

      10.1038/s41440-019-0216-8

    • Related Report
      2018 Annual Research Report
    • Peer Reviewed
  • [Journal Article] Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers in hypertensive patients with myocardial infarction or heart failure: a systematic review and meta-analysis2019

    • Author(s)
      Ohtsubo T、Shibata R、Kai H、Okamoto R、Kumagai E、Kawano H、Fujiwara A、Kitazono T、Murohara T、Hisatomi A
    • Journal Title

      Hypertension Research

      Volume: 42 Issue: 5 Pages: 641-649

    • DOI

      10.1038/s41440-018-0167-5

    • Related Report
      2018 Annual Research Report
    • Peer Reviewed
  • [Journal Article] Effects of lowering diastolic blood pressure to <80 mmHg on cardiovascular mortality and events in patients with coronary artery disease: a systematic review and meta-analysis2019

    • Author(s)
      Okamoto R、Kumagai E、Kai H、Shibata R、Ohtsubo T、Kawano H、Fujiwara A、Ito M、Fukumoto Y、Hisatomi A
    • Journal Title

      Hypertension Research

      Volume: 42 Issue: 5 Pages: 650-659

    • DOI

      10.1038/s41440-018-0189-z

    • Related Report
      2018 Annual Research Report
    • Peer Reviewed
  • [Journal Article] 血圧変動の臓器障害メカニズム2018

    • Author(s)
      甲斐久史、山路和伯、柴田 怜
    • Journal Title

      血圧

      Volume: 25 Pages: 188-193

    • Related Report
      2018 Annual Research Report
  • [Journal Article] 心血管疾患(脳卒中・冠動脈疾患)合併例の診療2018

    • Author(s)
      甲斐久史、吉村晴美、翁長春貴、力武美子
    • Journal Title

      日本臨牀

      Volume: 76 Pages: 1333-1339

    • Related Report
      2018 Annual Research Report
  • [Journal Article] Losartan/Hydrochlorothiazide combination is safe and effective for morning hypertension in very elderly patients.2018

    • Author(s)
      Uchiwa H, Kai H, Iwamoto Y, Anegawa T, Kajimoto H, Fukuda K, Imaizumi T, Fukumoto Y.
    • Journal Title

      Clin Exp Hypertens

      Volume: 40 Issue: 3 Pages: 267-273

    • DOI

      10.1080/10641963.2017.1368536

    • Related Report
      2017 Research-status Report
    • Peer Reviewed
  • [Journal Article] Cerebral microbleeds in coronary artery disease patients during antiplatelet therapy.2017

    • Author(s)
      Iwamoto Y, Kai H, Fukuda K, Uchiwa H, Anegawa T, Aoki Y, Kajimoto H, Uchiyamae Y, Abe T, Imaizumi T, Fukumoto Y.
    • Journal Title

      Int J Cardiovasc Res

      Volume: 6 Issue: 06 Pages: 1000329-1000329

    • DOI

      10.4172/2324-8602.1000329

    • Related Report
      2017 Research-status Report
    • Peer Reviewed / Open Access
  • [Journal Article] New diagnostic index for sarcopenia in patients with cardiovascular diseases.2017

    • Author(s)
      Harada H, Kai H, Shibata R, Niiyama H, Nishiyama Y, Murohara T, Yoshida N, Katoh A, Ikeda H.
    • Journal Title

      Plos One

      Volume: 12 Issue: 5 Pages: e0178123-e0178123

    • DOI

      10.1371/journal.pone.0178123

    • Related Report
      2017 Research-status Report
    • Peer Reviewed
  • [Journal Article] Effectiveness of cardiac rehabilitation for prevention and treatment of sarcopenia in patients with cardiovascular disease - A retrospective cross-sectional analysis2017

    • Author(s)
      Harada H, Kai H, Niiyama H, Nishiyama Y, Katoh A, Yoshida N, Fukumoto Y, Ikeda H.
    • Journal Title

      J Nutr Health Aging

      Volume: 21 Issue: 4 Pages: 449-456

    • DOI

      10.1007/s12603-016-0743-9

    • Related Report
      2017 Research-status Report
    • Peer Reviewed
  • [Journal Article] Oral Administration of Glucosamine Improves Vascular Endothelial Function by Modulating Intracellular Redox State2017

    • Author(s)
      Katoh A, Kai H, Harada H, Niiyama H, Ikesa H.
    • Journal Title

      International Heart Journal

      Volume: 58 Issue: 6 Pages: 926-932

    • DOI

      10.1536/ihj.16-534

    • NAID

      130006251741

    • ISSN
      1349-2365, 1349-3299
    • Related Report
      2017 Research-status Report
    • Peer Reviewed
  • [Journal Article] Impact of systolic blood pressure on hemorrhagic stroke in patients with coronary artery disease during anti-platelet therapy: The Japanese Coronary Artery Disease (JCAD) Study.2016

    • Author(s)
      Kai H, Kohro T, Fukuda K, Yamazaki T, Nagai R.
    • Journal Title

      International Journal of Cardiology

      Volume: 224 Pages: 112-113

    • DOI

      10.1016/j.ijcard.2016.09.004

    • Related Report
      2016 Research-status Report
    • Peer Reviewed
  • [Journal Article] Impact of Low Diastolic Blood Pressure on Risk of Cardiovascular Death in Elderly Patients With Coronary Artery Disease After Revascularization – The CREDO-Kyoto Registry Cohort-1 –2016

    • Author(s)
      Kai H, Kimura T, Fukuda K, Fukumoto Y, Kakuma T, Furukawa Y; CREDO-Kyoto Investigators.
    • Journal Title

      Circulation Journal

      Volume: 80 Issue: 5 Pages: 1232-1241

    • DOI

      10.1253/circj.CJ-15-1151

    • NAID

      130005147673

    • ISSN
      1346-9843, 1347-4820
    • Related Report
      2016 Research-status Report
    • Peer Reviewed / Open Access
  • [Presentation] Effects of low blood pressure on cardiovascular events in diabetic patients with coronary artery disease after revascularization - The CREDO-Kyoto cohort-1.2018

    • Author(s)
      Kai H, Kimura T, Furukawa Y
    • Organizer
      86th European Atherosclerosis Society
    • Related Report
      2018 Annual Research Report
    • Int'l Joint Research
  • [Presentation] Effects of low blood pressure on cardiovascular events in diabetic patients with coronary artery disease after revascularization - The CREDO-Kyoto cohort-1.2018

    • Author(s)
      Kai H, Niiyama H, Rikitake-Iwamoto, Harada H, Katoh A, Furukawa Y, Kimura T.
    • Organizer
      European Society of Cardiology Congress 2018
    • Related Report
      2018 Annual Research Report
    • Int'l Joint Research
  • [Presentation] Risks of cerebral microbleeds in patients with coronary artery disease on antiplatelet therapy.2018

    • Author(s)
      Rikitake-Iwamoto Y, Anegawa T, Fukuda K, Kai H.
    • Organizer
      27th International Society of Hypertension Annual Scientific Meeting: Hypertension Beijing 2018
    • Related Report
      2018 Annual Research Report
    • Int'l Joint Research
  • [Presentation] 「Hypertension Paradoxへの挑戦」合併症を考慮した厳格な血圧管理2018

    • Author(s)
      甲斐久史
    • Organizer
      第41回日本高血圧学会学術集会
    • Related Report
      2018 Annual Research Report
  • [Presentation] 抗血栓療法新時代の降圧療法2017

    • Author(s)
      甲斐久史
    • Organizer
      第6回臨床高血圧フォーラム
    • Related Report
      2017 Research-status Report
  • [Presentation] Losartan/HCTZ combination therapy is safe and useful in controlling morning hypertension in very elderly patients.2017

    • Author(s)
      Kai H, Uchiwa H, Iwamoto Y, Fukuda K, Imaizumi T.
    • Organizer
      European Society of Hypertension and Cardiovascular Protection 2017
    • Related Report
      2017 Research-status Report
    • Int'l Joint Research
  • [Presentation] The effects of ezatimibe on coronary plaque volume in patients with stable angina pectoris previously treated with statin.2017

    • Author(s)
      Katoh A, Hattori Y, Yoshikawa N, Niiyama H, Harada H, Kai H, Ikeda H.
    • Organizer
      European Society of Cardiology Congress 2017
    • Related Report
      2017 Research-status Report
    • Int'l Joint Research
  • [Presentation] シンポジウム12「Post-SPRINTの日本人高血圧治療戦略」冠動脈疾患の降圧治療を再考するー拡張期血圧をどう考えるか2017

    • Author(s)
      甲斐久史
    • Organizer
      第41回日本心臓病学会学術集会
    • Related Report
      2017 Research-status Report
  • [Presentation] シンポジウム4「心不全予防と降圧療法」降圧療法による心不全予防2017

    • Author(s)
      甲斐久史
    • Organizer
      第40回日本高血圧学会学術集会
    • Related Report
      2017 Research-status Report
  • [Presentation] ARB/CCB併用療法は家庭血圧日間変動抑制においてARB/HCTZ併用療法より優れているか?2017

    • Author(s)
      甲斐久史、今泉勉
    • Organizer
      第21回日本心不全学会学術集会
    • Related Report
      2017 Research-status Report
  • [Presentation] ミニシンポジウム「降圧目標を再考する」冠動脈疾患患者の降圧目標ーJカーブ現象をどこまで考慮するか2016

    • Author(s)
      甲斐久史
    • Organizer
      第41回日本高血圧学会学術集会
    • Place of Presentation
      仙台市
    • Year and Date
      2016-09-30
    • Related Report
      2016 Research-status Report
  • [Presentation] Symposium 5: “Challenges to the classic paradigm of the hypertensive heart disease” Fibro-inflammatory changes during progression of systolic/diastolic dysfunction in the hypertensive heart.2016

    • Author(s)
      Kai H.
    • Organizer
      26th International Society of Hypertension Annual Scientific Meeting 2016: Hypertension in Seoul 2016
    • Place of Presentation
      Seoul, Korea
    • Year and Date
      2016-09-24
    • Related Report
      2016 Research-status Report
    • Int'l Joint Research / Invited
  • [Presentation] シンポジウム5「高血圧治療を臓器管理に生かす」冠動脈疾患と高血圧2016

    • Author(s)
      甲斐久史
    • Organizer
      第64回日本心臓病学会学術集会
    • Place of Presentation
      東京
    • Year and Date
      2016-09-23
    • Related Report
      2016 Research-status Report
  • [Presentation] Eight-month antiplatelet therapy increased cerebral microbleeds in coronary artery disease patients with poor blood pressure control and severe coronary lesions.2016

    • Author(s)
      Iwamoto Y, Kai H, Fykuda K, Anegawa T, Aoki Y, Uchiwa H, Imaizumi T, Fukumoto Y.
    • Organizer
      European Society of Cardiology Congress 2016
    • Place of Presentation
      Roma, Italia
    • Year and Date
      2016-08-27
    • Related Report
      2016 Research-status Report
    • Int'l Joint Research
  • [Presentation] Is ARB/CCB combination superior to ARB/HCTZ combination in day-by-day blood pressure variability reduction? A prospective randomized trial.2016

    • Author(s)
      Kai H, Imaizumi T.
    • Organizer
      European Society of Cardiology Congress 2016
    • Place of Presentation
      Roma, Italia
    • Year and Date
      2016-08-27
    • Related Report
      2016 Research-status Report
    • Int'l Joint Research

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Published: 2016-04-21   Modified: 2020-03-30  

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