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1. 直接経口抗凝固薬（DOAC）と非経口直接作用型抗凝固薬：用量および副作用direct oral anticoagulants doacs and parenteral direct acting anticoagulants dosing and adverse effects [show details]
… parenteral direct thrombin inhibitor to an oral anticoagulant is discussed separately: Argatroban to warfarin – Bivalirudin to warfarin – Aspects of anticoagulant transitioning specific to individuals with …
2. 心房細動：血栓塞栓症予防のための抗凝固療法atrial fibrillation anticoagulant therapy to prevent thromboembolism [show details]
… The reversal of the anticoagulant effect of warfarin and NOAC agents is discussed separately. Some patients may need to be switched from NOAC agent to warfarin, from warfarin to NOAC, or between NOAC …
3. 抗凝固療法を受けた患者の周術期マネージメントperioperative management of patients receiving anticoagulants [show details]
… not seem to alter rivaroxaban anticoagulant effect. Unlike the PT/INR for warfarin, routine coagulation tests have not been validated for ensuring that the rivaroxaban anticoagulant effect has resolved …
4. 静脈血栓塞栓症：初期マネージメント後の抗凝固療法venous thromboembolism anticoagulation after initial management [show details]
… long-term anticoagulation include oral anticoagulants (ie, factor Xa inhibitors, direct thrombin inhibitors, and warfarin) and parenteral subcutaneous anticoagulants (low molecular weight [LMW] heparin and fondaparinux) …
5. 静脈血栓塞栓症：抗凝固療法の開始（開始後10日間） venous thromboembolism initiation of anticoagulation first 10 days [show details]
… ingestion). Rivaroxaban and apixaban were evaluated as anticoagulants without prior administration of heparin (ie, monotherapy); as such they may be used as the sole initial anticoagulant. However, anticoagulant …

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関連記事	「補体」「物質」「質」

「補体」

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英: complement
同: アレキシン alexin
関: 補体活性化経路、補体価

図：IMM.63

pathway	start	first step
classical pathway	antigen-antibody complex	C1q, C1r, C1s, C4, C2
lectin pathway	mannose-binding lectin or ficolin binds carbohydrate on pathogen surface	MBL/ficolin, MASP-2, C4, C2
alternative pathway	pathogen surface	C3, B, D

補体の相互作用 IMM.62

古典的経路 classical pathway

C1qがカスケードの最初となる。3つの方法で補体カスケードがはじまる。

(1)多価陰イオン表面(例えば、グラム陰性細菌のリポテイコ酸)
(2)バクテリアの多糖のホスホコリンに結合(例えば肺炎球菌のC蛋白質)
(3)抗原抗体複合体に結合して自然免疫と獲得免疫のエフェクター機構を結びつける。

レクチン経路 lectin pathway

炭化水素鎖を認識するレクチンがカスケードの最初となる。

1. lectin MBL：mannose-containing carbohydrates
2. ficolin　：N-acetylglucosamine

代替経路 alternative pathway

C3からはじまる。血漿中のC3が病原体の表面で自発的に活性化されることで補体反応がはじまる。

３つの経路は共通してC3 convertaseを生成。C3 convertaseはC3→C3a+C3b
C3a: C3a is a peptide mediator of local inflammation
C3b: C3b binds covalently to the bacterial cell membrane and opsonizes the bacteria

C5 convertaseはC3bにC3 convertaseが結合してできる
C5 converaseはC5→C5a+C5b
C5a: powerful peptide mediator of inflammation
C5b: C5b,C6,C7,C8,C9: membrane-attack complex

C3aとC5a。C4a

炎症部位に血管外に抗体、補体、食細胞を集め、組織液を増やすことで抗原提示細胞がリンパ節に移動するのを促進する(IMM.75)

C5a,C3a,C4a: smooth muscle contraction.(IMM.75)
C5a,C3a: act on the endo thelial cells lining blood vessels to induce adhesion molecules.(IMM.75)
C5a>C3a>C4a: increase in blood flow, increase vascular permeability, increase binding of phagocytes to exdothielial cells.(IMM.76)
C5a: activates mast cells to release mediators, such as histamine and TNF-α. that contribute the inflammatory response(IMM.76).
C5a: acts directly on neutrophils and monocytes and attracting neutrophils and monocytes(IMM.75)
C3a: contributes to the pypotension and edema seen in endotoxic shock
C5a: activated by endotoxin, funcions in neutrophil chemotaxis