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2021 대한부정맥학회 심방세동의 선별 검사 및 무증상 심방세동의 관리 지침
이정명 ( Jung Myung Lee ),김태훈 ( Tae-hoon Kim ),박진규 ( Jin-kyu Park ),정보영 ( Boyoung Joung ),최의근 ( Eue-keun Choi ) 대한내과학회 2021 대한내과학회지 Vol.96 No.2
Atrial fibrillation (AF) is a strong risk factor for embolic stroke. In patients with AF, optimal anticoagulation therapy, administered according to the stroke risk scoring system, can effectively reduce the stroke risk. However, AF episodes are frequently asymptomatic, with a significant number of them detected after a stroke event. Therefore, the early detection of subclinical AF and the subsequent administration of optimal oral anticoagulation therapy is expected to reduce the risk of stroke. However, this strategy requires more effective screening for the detection of AF in the asymptomatic stage, which accounts for the recent research interest in silent/subclinical AF. Today, the widespread use of cardiac implantable electronic devices and wearable rhythm monitors has enabled the detection of atrial high-rate episodes/subclinical AF in a substantial number of patients. The risk of stroke appears to be related to the duration of this phenomenon. Subclinical AF increases the risk of stroke, but generally not as much as clinical AF, but whether long-term anticoagulation therapy is required in patients with subclinical AF is unclear. Here we review existing data on the epidemiology, clinical significance, and suggest guidelines on management of subclinical AF and the optimal screening strategies aimed at its detection. (Korean J Med 2021;96:76-84)
2018 대한부정맥학회 심방세동 환자에서 NOAC 사용 지침: 출혈의 대처와 수술 전후 복약관리
이지현 ( Ji Hyun Lee ),임홍의 ( Hong Euy Lim ),임우현 ( Woo-hyun Lim ),안진희 ( Jinhee Ahn ),차명진 ( Myung-jin Cha ),박준범 ( Junbeom Park ),이기홍 ( Ki Hong Lee ),박환철 ( Hwan-cheol Park ),최의근 ( Eue-keun Choi ),정보영 ( Boyo 대한내과학회 2019 대한내과학회지 Vol.94 No.1
Although non-vitamin K-antagonist oral anticoagulants (NOACs) reduce major bleeding events in patients with atrial fibrillation more effectively than does warfarin, a significant bleeding risk remains. Patients exhibiting current bleeding and those who are expected to bleed require appropriate management, because NOAC discontinuation may increase the thromboembolic risk. This article details general management principles for patients experiencing current bleeding and those undergoing invasive surgery while on NOACs. (Korean J Med 2019;94:40-56)
만성 신질환 심방 세동 환자에서 혈전 색전증의 독립적 위험인자
오규철 ( Gyu Chul Oh ),차명진 ( Myung Jin Cha ),강도윤 ( Do Yoon Kang ),김지영 ( Ji Yeong Kim ),성영준 ( Young Jun Sung ),윤정한 ( Jung Han Yoon ),이동원 ( Dong Won Lee ),이민호 ( Min Ho Lee ),최원석 ( Won Seok Choe ),최의근 ( Eue 대한내과학회 2011 대한내과학회지 Vol.81 No.4
Background/Aims: The CHADS2 scoring system has been widely used to stratify thromboembolic risk associated with atrial fibrillation. Chronic kidney disease (CKD) is associated with increased risk of stroke in patients with atrial fibrillation (AF) but has not yet been included in risk-scoring systems. We analyzed the difference in thromboembolic risk of patients with AF and a moderate risk of stroke according to the presence of CKD. Methods: Of 1,952 patients with AF, 451 with a CHADS2 score of 1 were divided into two groups according to the presence of CKD, and thromboembolic events were analyzed. Each group was further classified by the antithrombotic regimen used: warfarin or aspirin. Results: Of the 451 patients, 94 with CKD had a significantly higher risk for thromboembolic complications than the 357 patients without CKD (hazard ratio [HR], 3.630; 95% confidence interval [CI], 1.565-8.422; p=0.003). Patients with CKD who were on aspirin had a higher risk for thromboembolic events than those on warfarin (HR, 5.203; 95% CI, 1.056-25.633, p=0.043). However, in patients without CKD, the aspirin group did not have a higher risk of thromboembolic events than the warfarin group (HR, 0.803; 95% CI, 0.225-2.867, p=0.735). Conclusions: In Korean patients with AF and a CHADS2 score of 1, CKD may be an independent thromboembolic risk factor. In patients with CKD, warfarin may be superior to aspirin for lowering thromboembolic risk. (Korean J Med 2011;81:464-469)