J Korean Neurol Assoc.  2016 Aug;34(3):184-192. 10.17340/jkna.2016.3.3.

Focused Update of Guidelines for Antithrombotic Management of Patients with Atrial Fibrillation and Ischemic Stroke or Transient Ischemic Attack

Affiliations
  • 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 Hospital, 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.

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.

Keyword

Oral anticoagulant; Ischemic stroke; Secondary prevention; Atrial fibrillation; Dabigatran; Rivaroxaban; Apixaban

MeSH Terms

Anticoagulants
Atrial Fibrillation*
Dabigatran
Drug Interactions
Half-Life
Humans
Ischemic Attack, Transient*
Mortality
Pharmacokinetics
Plasma
Recurrence
Rivaroxaban
Secondary Prevention
Stroke*
Thrombin
Warfarin
Anticoagulants
Dabigatran
Rivaroxaban
Thrombin
Warfarin
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