わが国の「予防ガイドライン」473)，抗凝固療法の使用法 について改訂された
ACCP
ガイドライン（2012
）644)，および 脳神経疾患のPTE
死亡例が報告されている日本医療安全 調査機構の「提言」649)を参考に改訂した．「提言」の死亡症 例検討では，8
人中3
人が脳神経疾患，2
人は術後であった．脳腫瘍以外の開頭術は中リスク，脳腫瘍の開頭術は高リ スクとする．
大量のステロイド薬を併用する場合には，さらにリスク が高くなるものと考える．
脳神経外科手術では，抗凝固療法による脳出血の増加
亢進状態にくわえ，手術，化学療法，放射線治療，中心静 脈カテーテル留置などの侵襲処置・治療によって
VTE
が 発症しやすい．近年の化学療法の進歩により，長期間にわ たりさまざまな種類の抗癌剤を使用する機会が増えてきて いるため，治療中にVTE
の発症に留意する必要がある．日本医療安全調査機構の「提言」649)にもあるように，治療 中は
VTE
の発症を念頭においた患者教育を行い，VTE
の 早期発見・早期治療を心がける必要がある．とくに，入 院・臥床・入院化学療法などVTE
リスクを増大させる要 因がある場合は弾性ストッキングやIPC
を行うことを推奨 する．呼吸不全や重症感染症患者は中リスクと判断し，長期臥 床を要する場合には弾性ストッキングや
IPC
を使用する．うっ血性心不全患者は高リスクと判断するが，弾性ス トッキング，
IPC
の使用は静脈還流量増加による病態増悪 が危惧される場合があり，注意して使用する．場合によっ ては低用量未分画ヘパリンを選択する．カテーテル検査・治療後は，穿刺部位の止血のための必 要以上に長時間の圧迫は避け，安静時間の短縮を図る．
潰瘍性大腸炎やクローン病などの炎症性腸疾患は中リス クとみなし，長期臥床を要する場合には弾性ストッキング
や
IPC
を使用する．内科集中治療症例では危険因子が重複することが多く，
リスクの程度に応じた
VTE
の予防を徹底する．5.
おわりに
VTE
の予防に関して，日本人のデータは少しずつ蓄積さ れつつあるが，いまだ十分ではない．したがって，上述の 予防法は欧米のガイドラインのように十分なエビデンスに 基づいたものではなく，VTE
の予防を考慮する際の1
つの 指針にすぎないことを念頭に置く必要がある．また，VTE
の危険因子には未解明部分があり，元来，VTE
の完全な 予防は不可能である．よって，個々の症例に対するリスク 評価や予防法は，本ガイドラインを参考にしつつも，最終 的には主治医がその責任において決定しなければならな い．合併症の危険を伴う予防法の施行においては，患者と 十分に話し合い，インフォームドコンセントを得る必要が ある．付表 肺血栓塞栓症および深部静脈血栓症の診断，治療，予防に関するガイドライン 班構成員の利益相反（COI）に関する開示 著者 雇用または
指導的地位
（民間企業） 株主 特許権使用料 謝金 原稿料 研究資金提供 奨学（奨励）寄附金/ 寄附講座 その他
の報酬
配偶者・一親等内の親族，
または収入・財産を共有 する者についての申告
班長：伊藤 正明 第一三共
武田薬品工業
ブリストル・
マイヤーズ スクイブ第一三共
ブリストル・マイ ヤーズスクイブ MSD塩野義製薬 大塚製薬
班員：池田 正孝 第一三共
班員：荻野 均
テルモジェイ・
シー・ティー
班員：佐藤 徹
アクテリオンファー マシューティカルズ ジャパン
アクテリオ ンファーマ シューティ カルズジャ パン 班員：佐戸川 弘之 第一三共
班員：田邉 信宏
アクテリオンファー マシューティカルズ 日本新薬ジャパン
バイエル薬品 第一三共ファイザー
日本新薬アクテリオンファー マシューティカルズ ジャパン
班員：中村 真潮 第一三共
班員：福田 幾夫
第一三共バイエル薬品
ファイザー バイエル薬品
班員：松原 広己
アクテリオンファー マシューティカルズ ジャパンバイエル薬品
日本新薬
班員：孟 真 バイエル薬品
第一三共 班員：山田 典一
バイエル薬品 第一三共川澄化学工業 協力員：清水 一寛 第一三共
バイエル薬品
協力員：杉村 宏一郎
第一三共バイエル薬品 大日本住友製薬 大塚製薬サノフィ 協力員：保田 知生 第一三共
協力員：山本 剛
バイエル薬品 第一三共ブリストル・マイ ヤーズスクイブ ファイザー 法人表記は省略．上記以外の班員・協力員については特になし．
班員：石橋 宏之 なし 班員：應儀 成二 なし 班員：小泉 淳 なし
班員：田島 廣之 なし 班員：宮原 嘉之 なし 協力員：島袋 伸洋 なし
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