2021 대한부정맥학회 심방세동 환자의 뇌졸중 예방 관리 지침2021 Korean Heart Rhythm Society Guidelines for Stroke Prevention in Atrial Fibrillation
- Authors
- 이기홍; 김진배; 신승용; 정보영
- Issue Date
- 2021
- Publisher
- 대한내과학회
- Keywords
- Atrial fibrillation; Stroke; Hemorrhage; Thrombosis; Embolism
- Citation
- 대한내과학회지, v.96, no.4, pp 296 - 311
- Pages
- 16
- Journal Title
- 대한내과학회지
- Volume
- 96
- Number
- 4
- Start Page
- 296
- End Page
- 311
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/51764
- DOI
- 10.3904/kjm.2021.96.4.296
- ISSN
- 1738-9364
2289-0769
- Abstract
- Atrial fibrillation (AF) is a strong risk factor for ischemic stroke and systemic embolism. To prevent thromboembolic events in patients with AF, anticoagulation therapy is essential. The anticoagulant strategy is determined after stroke and bleeding risk assessments using the CHA2DS2-VASc and HAS-BLED scores, respectively; both consider clinical risk factors. Vitamin K antagonists (VKAs) are the sole anticoagulant option in AF patients with a prosthetic mechanical valve or moderate-severe mitral stenosis; in all other AF patients VKA or non-vitamin K antagonist oral anticoagulants are therapeutic options. However, antiplatelet therapy should not be used for stroke prevention in AF patients. Anticoagulation is not needed in AF patients with low stroke risk but strongly recommended in those with a with low bleeding risk. Left atrial appendage (LAA) occlusion offers an alternative in AF patients in whom long-term anticoagulation is contraindicated. Surgical occlusion or the exclusion of LAA can be considered for stroke prevention in AF patients undergoing cardiac surgery. In this article, we review existing data for stroke prevention and suggest optimal strategies to prevent stroke in AF patients.
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