J Stroke.
2015 May;17(2):210-215. 10.5853/jos.2015.17.2.210.
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
- Affiliations
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- 1Department of Neurology, Seoul National University Hospital, Seoul, Korea.
- 2Department of Neurology, Hallym Neurological Institute, Anyang, Korea. ykh1030@hallym.ac.kr
- 3Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
- 4Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
- 5Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
- 6Department of Neurology, Inha University Hospital, Incheon, Korea.
- 7Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
- 8Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
- KMID: 2223677
- DOI: http://doi.org/10.5853/jos.2015.17.2.210
Abstract
- 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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