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KMID : 0858420120140030106
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Korean Journal of Stroke
2012 Volume.14 No. 3 p.106 ~ p.115
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Focused Update on Primary Stroke Prevention in Patients with Atrial Fibrillation in Korean Clinical Practice Guidelines for Stroke
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Park Jong-Moo
Hong Keun-Sik
Han Sang-Won
Kim Hahn-Young
Cho Yong-Jin
Kang Kyu-Sik
Yu Kyung-Ho
Rha Joung-Ho
Heo Ji-Hoe
Kwon Sun-Uck
Oh Chang-Wan
Bae Hee-Joon
Lee Byung-Chul
Yoon Byung-Woo
Koo Ja-Seong
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Abstract
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Pivotal clinical trials testing the efficacy of new antithrombotics for the prevention of stroke and systemic embolism in patients with atrial fibrillation have been published since the release of the first edition of Korean clinical practice guidelines for primary stroke prevention. From July 2007 to August 2012, 5 clinical studies and update of guidelines in Europe and North America were identified through systematic search. In patients with atrial fibrillation who were unsuitable for warfarin, the combination of clopidogrel and aspirin reduced the risk of stroke at the cost of increased major bleedings as compared to aspirin. In patients with nonvalvular atrial fibrillation and risk factors for stroke, new oral anticoagulants, dabigatran, rivaroxaban and apixaban, were as effective as or more effective than warfarin in preventing stroke or systemic embolism. The risks of major bleeding with novel anticoagulants were similar to or lower than that of warfarin. Particularly, the risk of intracranial bleeding was significantly lower with novel anticoagulants than with warfarin. In this report, we summarized the new evidences and updated our recommendations for primary stroke prevention in patients with atrial fibrillation.
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KEYWORD
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Stroke, Practice guideline, Primary prevention, Atrial fibrillation, Antithrombotic therapy
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