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KMID : 1142120150170020210
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Journal of Stroke
2015 Volume.17 No. 2 p.210 ~ p.215
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Antithrombotic Management of Patients with Nonvalvular Atrial Fibrillation and Ischemic Stroke or Transient Ischemic Attack: Executive Summary of the Korean Clinical Practice Guidelines for Stroke
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Jung Keun-Hwa
Yu Kyung-Ho
Kim Young-Dae
Park Jong-Moo
Hong Keun-Sik
Rha Joung-Ho
Kwon Sun-U.
Bae Hee-Joon
Heo Ji-Hoe
Lee Byung-Chul
Yoon Byung-Woo
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Abstract
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Cardioembolic stroke related to nonvalvular atrial fibrillation is associated with a high recurrence rate and high mortality and morbidity. In this population, therefore, optimal anticoagulant therapy is required to prevent the occurrence of second stroke. Oral anticoagulant, warfarin has been traditionally used, but it is greatly limited by its narrow efficacy window, complex pharmacokinetics, and multiple drug interactions, thus requiring frequent blood monitoring. Recently, oral anticoagulants targeted for a specific coagulation component have been newly developed and tested in large clinical trials. Dabigatran, direct thrombin inhibitor, and rivaroxaban, apixaban, and edoxaban, inhibitors of factor Xa harbor great merits of rapid action time, short half-life, stable plasma concentration, and little drug interaction. Recently, large randomized clinical trials and meta-analyses have been published to show the efficacy and safety of the new oral anticoagulants compared with warfarin. Based on the results from recent clinical trials, we revised recommendations to apply optimal anticoagulant therapy in patients with nonvalvular atrial fibrillation and ischemic stroke or transient ischemic attack.
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KEYWORD
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Atrial fibrillation, Secondary prevention, Stroke, Warfarin, New anticoagulant
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