Chronic Obstructive Pulmonary Disease in Super-Aged Society: A Letter From the Near Future

황헌규 대한의학회 2023 Journal of Korean medical science Vol.38 No.14

Incidence and Risk Factors of Recurrent Venous Thromboembolism after Pulmonary Embolism

황헌규,최원일,이보라,이충원 대한결핵및호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.4

Background: Information about the epidemiology of venous thromboembolism (VTE) recurrence in Korea is lacking. The purpose of this study was to investigate VTE cumulative recurrence rates and identify risk factors for VTE recurrence among Korean adults. Methods: A retrospective cohort study was conducted on adult patients (≥18 years) admitted to a university teaching hospital for pulmonary embolism (PE) from 2005 to 2013. The main outcome of interest was a recurrence of VTE. We used Cox proportional hazard regression analyses to calculate the relative risk of VTE recurrence. Results: Five-year cumulative incidence of recurrent VTE events was 21.5% (95% confidence interval [CI], 17.7–25.4) in all cases of PE; 17% after provoked and 27% after unprovoked PE. Multivariate analysis showed that body mass index (BMI) of ≥25 (hazard ratio [HR], 2.02; 95% CI, 1.17–3.46; p=0.01) and longer anticoagulation therapy duration (HR, 0.90; 95% CI, 0.84–0.96; p<0.01) were independently associated with risk of VTE recurrence. Risk factors not found to be statistically significant at the <0.05 level included history of VTE (HR, 1.81; 95% CI, 0.84–3.88; p=0.12), unprovoked PE (HR, 1.70; 95% CI, 0.89–3.25; p=0.10), symptomatic deep vein thrombosis (HR, 1.62; 95% CI, 0.89–2.94; p=0.10), and female sex (HR, 1.42; 95% CI, 0.78–2.55; p=0.24). We found that age, history of cancer, and other co-morbidities did not significantly affect the risk of VTE recurrence. Conclusion: Recurrence of VTE after PE is high. Patients with BMI ≥25 or reduced anticoagulation therapy duration have a higher risk of recurrent VTE.

Risk Factors Influencing Rebleeding after Bronchial Artery Embolization on the Management of Hemoptysis Associated with Pulmonary Tuberculosis

황헌규,이호성,최재성,서기현,김용훈,나주옥 대한결핵및호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.74 No.3

Background: Hemoptysis due to pulmonary tuberculosis (TB) frequently develops in Korea where the prevalence of TB is intermediate. The effect of bronchial artery embolization (BAE) on the control of massive hemoptysis has been well known. This study is designed to identify the risk factors contributing to rebleeding after BAE in patients with TB. Methods: We retrospectively evaluated risk factors and the time for rebleeding after BAE in 72 patients presenting with hemoptysis. Results: The overall immediate success rate of BAE was 93.1% (67 of 72 patients). Of the 29 patients (40.3%) who showed rebleeding after BAE, 13 patients experienced rebleeding within 1 month, and 14 patients between 1 month to 1 year. The existence of a shunt in angiographic finding, aspergilloma, and diabetes mellitus were risk factors of rebleeding after BAE in multivariate analysis. Conclusion: BAE was very effective for obtaining immediate bleeding control in hemoptysis associated with active TB or post-TB sequelae. It is important to observe whether or not rebleeding occurs up to 1 year of BAE especially in TB patients with aspergilloma, DM, or a shunt. Even rebleeding can be managed well by second BAE.

The Perioperative Management of Antithrombotic Therapies Using Enoxaparin

황헌규,구소미,어수택,김양기 대한의학회 2017 Journal of Korean medical science Vol.32 No.6

Oral anticoagulant therapy is frequently and increasingly prescribed for patients at risk of arterial or venous thromboembolism (VTE). Although elective surgical or invasive procedures have necessitated temporary interruption of anticoagulants, managing these patients has been performed empirically and been poorly investigated. This study was designed to evaluate the adequacy of perioperative anticoagulation using enoxaparin. This was a retrospective, single-center study that evaluated the efficacy and safety of therapeutic-dose enoxaparin for bridging therapy in patients on long-term warfarin at Soonchunhyang University Hospital in Korea between August 2009 and July 2011. Warfarin was discontinued 5 days before surgery, and enoxaparin was administered twice daily by subcutaneous injection at a dose of 1 mg per kg from 3 days before the procedure to the last dose 24 hours before the procedure. Anticoagulation was restarted if proper hemostasis had been confirmed. There were 49 patients, of whom 25 (51%) were men, and the mean age was 63 years. Thirty-four (69%) received warfarin therapy for VTE, and 9 (18%) for atrial fibrillation. Twenty-nine patients (59%) underwent major surgery and 20 (41%) minor surgery. The mean postoperative duration of enoxaparin was 4 days. No patients had thromboembolic complications through 30 days after the procedure. The overall 30-day mortality rate was 0%. In conclusion, our findings demonstrate that bridging therapy with therapeutic-dose enoxaparin is feasible and associated with a low incidence of major bleeding and no thromboembolic complications. However, the optimal approach to managing patients perioperatively is uncertain and requires further evaluation.

호흡기계 중환자실에서 치료관리된 급성호흡곤란증후군의 임상특성

황헌규,문승혁,어수택,김용훈,박춘식 대한결핵 및 호흡기학회 1998 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.87 No.0

F-145 : 구미시 불산누출로 인한 호흡기계 영향 분석

황헌규,김명신,임건일,양승부,임한혁,윤성용,김진석,우극현 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

목적: 2012년 9월 27일 구미시에서 발생한 불화수소 노출로 인한 호흡기계 급만성 후유증에 대한 건강검진과 설문조사를 실시하고 추적조사를 하여 치료와 유사상황의 대처방안 자료를 마련하고자 하였다. 연구방법: 제1단계 검사는 2012.10.13부터 2013.1.12 기간에 총인원 1,364명이 포함되었으며, 제2단계 검사는 2013.2.18부터 2013.6.3 기간에 병원에서 정밀 건강영향조사와 설문조사가 이루어졌다. 연구결과: 제1단계 건강영향조사 참여자 1394명중 161명 만이 2차 정밀검진에 참여하여 수검율이 11.5%였다. 수검자 중 110명(78%)이 중노출 이상의 노출수준으로 고노출 69명(48.9%), 중노출 41명(29.1%), 저노출 24명(17.0%), 비노출 7명(5.0%)이었다. 노출정도가 평가된 141명의 환자중에서 호흡기증세(호흡곤란, 기침, 객담)을 호소한 환자는 83명(58.9%)이었다. 노출수준이 높을수록 호흡곤란과 객담이 유의(p <0.05)하게 증가하였으며, 기침증세도 증가하는 양상을 보였다. 호흡곤란을 보인 환자는 사고당시 28명(19.9%)이었고, 2차검진당시 6명 (4.3%)로 감소하였으며, 노출정도에 따른 호흡곤란의 차이는 2차검진에서 관찰되지 않았다. 객담의 증세는 사고당시 41명(29.1%)에서 보였다가, 2차검진시 21명(14.9%)에서 객담의 증세를 호소하였고, 노출정도에 따른 객담증세의 차이는 2차검진에서 관찰되지 않았다. 기침증세는 사고당시 63명(44.7%)에서 호소하였고, 2차검진시 15명(10.6%)으로 감소하였다. 결론: 제2차검진에서 1차에 비하여 161명(11.5%)만이 참가한 제한점이 있으나, 고노출군에서 관찰된 호흡곤란과 기침증세는 약 6개월 지난 시점에서 감소하는 양상을 보였다. 객담의 증세는 고노출군에서 높은 양상이 남아있어 증세관리와 추적관찰이 필요하다. 추후 호흡기계에 미치는 영향평가를 위하여 흉부영상의 변화, 폐기능의 변화에 대한 추적검사가 필요할 것으로 보인다.

Diagnosis & Treatment of Pulmonary Embolism

황헌규 대한내과학회 2022 대한내과학회 춘계학술대회 Vol.2022 No.-

Trivial wheeze의 기관지 과민성과 기도염증의 분석

황헌규,주재학,김도진,기신영,어수택,김용훈,박춘식 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

Does the GOLD 2017 Classification Improve the Ability to Predict Exacerbation and Mortality?

황헌규 대한결핵및호흡기학회 2018 Tuberculosis and Respiratory Diseases Vol.81 No.3

폐색전증의 약물치료: 새로운 항응고제

황헌규,김양기 대한의사협회 2022 대한의사협회지 Vol.65 No.7

Background: Pulmonary embolism is associated with reduced survival and considerable economic burden worldwide. In Korea, the incidence of pulmonary embolism has been gradually increasing. Older individuals are at an increased risk for pulmonary embolism and anticoagulation-related bleeding events. Typically, heparin and vitamin K antagonists are employed to treat pulmonary embolism; however, these agents present numerous limitations. Hence, novel anticoagulants with improved safety and efficacy profiles are urgently needed. Current Concepts: Direct oral anticoagulants (DOACs), including direct thrombin (coagulation factor II) inhibitors and selective inhibitors of coagulation factor Xa, have emerged as alternative agents. Phase III, large-scale clinical trials have revealed that DOACs are non-inferior to standard therapy during initial and long-term treatment of pulmonary embolism, considering the safety profile. Evidence-based clinical guidelines recommend that primary care clinicians employ DOACs over warfarin to achieve anticoagulation. Discussion and Conclusion: For over 70 years, the standard therapy for most patients with pulmonary embolism has involved heparin administration, overlapped and followed by a vitamin K antagonist. Recently developed DOACs against coagulation factor Xa or thrombin might overcome limitations of standard therapy, including the need for injection and regular dose adjustment with laboratory monitoring. These limitations hinder the management of patients with pulmonary embolism and negatively impact the patient’s quality of life. Four DOACs, including apixaban, dabigatran, edoxaban, and rivaroxaban, are currently available for treating pulmonary embolism in Korea, which could simplify the therapeutic strategy.