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Advancing Bleeding Risk Prediction in Patients with Cerebrovascular and Cardiovascular Diseases Receiving Antithrombotic Therapy

Research Project

Project/Area Number 19K17023
Research Category

Grant-in-Aid for Early-Career Scientists

Allocation TypeMulti-year Fund
Review Section Basic Section 52020:Neurology-related
Research InstitutionNational Cardiovascular Center Research Institute

Principal Investigator

Tanaka Kanta  国立研究開発法人国立循環器病研究センター, 病院, 医師 (90818402)

Project Period (FY) 2019-04-01 – 2023-03-31
Project Status Completed (Fiscal Year 2022)
Budget Amount *help
¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000)
Fiscal Year 2021: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000)
Fiscal Year 2020: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000)
Fiscal Year 2019: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
Keywords出血 / 抗血栓療法 / 脳小血管病 / 抗血小板療法 / 抗凝固療法 / 脳血管障害 / 大出血 / 脳血管疾患 / 心血管疾患 / 頭蓋内出血 / 脳卒中
Outline of Research at the Start

申請者らは多様化する抗血栓薬の使用実態を解明するため「脳卒中研究者新ネットワークを活用した脳・心血管疾患における抗血栓療法の実態と安全性の解明The Bleeding with Antithrombotic Therapy Study 2(BAT2)」を進めてきた。国内51施設が参加し、特に脳小血管病の影響を検討するため、脳MRI撮影を登録要件として2016年10月から症例登録を開始し、2019年3月で約5,300例が登録された。本研究ではBAT2研究の全登録症例の2年間の観察を完遂し、抗血栓薬と出血合併症の関係を脳小血管病も絡めて解明し、診療実態に即した出血合併症リスク予測の方法を開発する。

Outline of Final Research Achievements

The Bleeding with Antithrombotic Therapy 2 (BAT2) is a multicenter prospective cohort study that enrolled patients with cerebrovascular and cardiovascular diseases who were taking oral antithrombotics from 52 hospitals nationwide. To investigate the impact of cerebral small vessel disease (SVD) on antithrombotic-related bleeding risks, brain MRI under prespecified conditions was mandatory for all patients at registration. All MRI examinations were interpreted by a central diagnostic committee. 5,378 patients were enrolled between 2016 and 2019, and follow-up was completed in April 2021. Analysis of baseline MRI data showed that albuminuria and reduced estimated glomerular filtration rate were independently associated with higher cerebral SVD burden. Another analysis showed that the total SVD score was predictive for intracranial hemorrhage and probably for extracranial bleeding, suggesting the broader clinical relevance of cerebral SVD as a marker for safe antithrombotic therapy.

Academic Significance and Societal Importance of the Research Achievements

本研究により、経口抗血栓薬を内服している脳血管疾患あるいは心血管疾患患者において、アルブミン尿と推算糸球体濾過量の低下が、脳小血管病(SVD)と関連していることが示された。また、フォローアップデータも含めた解析により、脳SVDが、頭蓋内出血だけでなく、消化管出血などの頭蓋外大出血のリスク因子となる可能性が示された。本研究成果から、主に大脳穿通枝領域の小血管病を反映するtotal SVD scoreと全身の高血圧性臓器障害との連関が支持された。また、脳SVDの包括的画像評価は、脳血管のみならず頭蓋外の小血管障害を捉える可能性があり、抗血栓療法を安全に実施する上で有用と考えられる。

Report

(5 results)
  • 2022 Annual Research Report   Final Research Report ( PDF )
  • 2021 Research-status Report
  • 2020 Research-status Report
  • 2019 Research-status Report
  • Research Products

    (6 results)

All 2023 2022 2020

All Journal Article (2 results) (of which Peer Reviewed: 2 results,  Open Access: 1 results) Presentation (4 results) (of which Int'l Joint Research: 2 results,  Invited: 2 results)

  • [Journal Article] Increased Cerebral Small Vessel Disease Burden With Renal Dysfunction and Albuminuria in Patients Taking Antithrombotic Agents: The Bleeding With Antithrombotic Therapy 22022

    • Author(s)
      Tanaka Kanta、Miwa Kaori、Takagi Masahito、Sasaki Makoto、Yakushiji Yusuke、Kudo Kohsuke、Shiozawa Masayuki、Tanaka Jun、Nishihara Masashi、Yamaguchi Yoshitaka、Fujita Kyohei、Honda Yuko、Kawano Hiroyuki、Ide Toshihiro、Yoshimura Sohei、Koga Masatoshi、Hirano Teruyuki、Toyoda Kazunori
    • Journal Title

      Journal of the American Heart Association

      Volume: 11 Issue: 6

    • DOI

      10.1161/jaha.121.024749

    • Related Report
      2022 Annual Research Report 2021 Research-status Report
    • Peer Reviewed / Open Access
  • [Journal Article] The bleeding with antithrombotic therapy study 2: Rationale, design, and baseline characteristics of the participants2020

    • Author(s)
      Takagi Masahito、Tanaka Kanta、Miwa Kaori、Sasaki Makoto、Koga Masatoshi、Hirano Teruyuki、et al
    • Journal Title

      European Stroke Journal

      Volume: 5 Issue: 4 Pages: 423-431

    • DOI

      10.1177/2396987320960618

    • Related Report
      2020 Research-status Report
    • Peer Reviewed
  • [Presentation] Cerebral Small Vessel Disease Burden For Bleeding Risk During Antithrombotic Therapy -BAT2-2023

    • Author(s)
      Tanaka K, Miwa K, Koga M, et al.
    • Organizer
      International Stroke Conference 2023
    • Related Report
      2022 Annual Research Report
    • Int'l Joint Research
  • [Presentation] Type 1 SVD (細動脈硬化症)と抗血栓療法2023

    • Author(s)
      田中寛大、三輪佳織、吉村壮平、古賀政利、豊田一則
    • Organizer
      Stroke 2023
    • Related Report
      2022 Annual Research Report
    • Invited
  • [Presentation] Total SVD scoreと抗血栓薬関連出血リスク2023

    • Author(s)
      田中寛大
    • Organizer
      第32回日本脳ドック学会総会
    • Related Report
      2022 Annual Research Report
    • Invited
  • [Presentation] Increased cerebral small vessel disease burden with renal dysfunction and albuminuria: the BAT22022

    • Author(s)
      Tanaka K, Miwa K, Takagi M, et al.
    • Organizer
      The 10th Korea-Japan Joint Stroke Conference
    • Related Report
      2022 Annual Research Report
    • Int'l Joint Research

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Published: 2019-04-18   Modified: 2024-01-30  

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