심방세동과 허혈뇌졸중 또는 일과성허혈발작을 가진환자에서 최신 항혈전치료에 대한 지침

Abstract

Cardioembolic stroke related to atrial fibrillation is problematic due to high recurrence, mortality, and morbidity rates. The optimal anticoagulant therapy therefore needs to be applied to prevent the occurrence of a second stroke in patients with nonvalvular atrial fibrillation. The oral anticoagulant warfarin has traditionally been used, but it is limited by its narrow efficacy window, complex pharmacokinetics, and multiple drug interactions, thus requiring frequent blood monitoring. New oral anticoagulants have recently been developed that target a specific coagulation component. Dabigatran (a direct thrombin inhibitor) and rivaroxaban, apixaban, and edoxaban (inhibitors of factor Xa) have advantages of rapid action time, short half-life, stable plasma concentration, and few drug interactions. Large randomized clinical trials and meta-analyses have recently been published on the efficacy and safety of these new oral anticoagulants. Based on the results obtained in recent clinical trials, we have revised the recommendations for selecting optimal anticoagulant therapy in patients with nonvalvular atrial fibrillation.