심방세동의 항응고 치료 가이드라인
Antithrombotic Therapy for Patients with Nonvalvular Atrial Fibrillation
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초록
심방세동의 유병률은 구미 선진국의 경우 전 인구의 약 1.5-2%에 이를 것으로 추정되며, 연령 증가에 따라 급속하게 증가하는 양상을 보여 80세 이상의 인구에서는 약 10%에 이르는 것으로 알려져 있다. 또한 정상인에 비해 뇌졸중의 빈도는 5배, 심부전의 빈도는 3배나 높아 합병증의 발생이 많고 불량한 예후를 보이는 것으로 알려져 있다[1].
Abstract
In patients with nonvalvular atrial fibrillation (AF), the risk of stroke is five times that of patients with a normal sinus rhythm. Antithrombotic therapy has a pivotal role for the prevention of stroke. With the advent of new oral anticoagulants (NOAC), the strategy of antithrombotic therapy has undergone significant changes due to its better efficacy, safety, and convenience when compared with warfarin or an antiplatelet regimen. Furthermore, new aspects of antithrombotic therapy in the prevention of stroke have revealed that the efficacy of antiplatelet regimens is weak while the risk of major bleeding is not significantly different to that of oral anticoagulant therapy, especially in the elderly. To reflect these pivotal changes, the previous guidelines for use of NOACs have been updated in recent years by various societies and associations. The Korean Heart Rhythm Society (KHRS) summarized the current evidence and updated its recommendations for stroke prevention in patients with nonvalvular AF. First of all, antithrombotic therapy must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient, especially with regard to balancing the benefit of stroke prevention with the risk of bleeding. They recommend using the CHA2DS2-VASc score rather than the CHADS2 score to assess the risk of stroke, and suggest the HAS-BLED score be used to validate bleeding risk. In patients with truly low risks (lone AF, CHA2DS2-VASc score of 0), no antithrombotic therapy is recommended, whereas oral anticoagulant (OAC) therapy, including warfarin (INR 2-3) or NOACs, is recommended in patients with a CHA2DS2-VASc score ≥ 2 unless contraindicated. In patients with a CHA2DS2-VASc score of 1, OAC therapy should be preferentially considered. When also factoring in the bleeding risk and patient preferences, antiplatelet therapy or no therapy could be the best treatment option.
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