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The Korean Heart Rhythm Society's 2014 Statement on Antithrombotic Therapy for Patients with Nonvalvular Atrial Fibrillation: Korean Heart Rhythm Society.

Jung BC, Kim NH, Nam GB, Park HW, On YK, Lee YS, Lim HE, Joung B, Cha TJ, Hwang GS, Oh S, Kim JS - Korean Circ J (2015)

Bottom Line: With the advent of novel oral anticoagulants (NOACs), the strategy for antithrombotic therapy has undergone significant changes due to its superior efficacy, safety and convenience compared with warfarin.In patients with truly low risk (lone AF, CHA2DS2-VASc score of 0), no antithrombotic therapy is recommended, whereas OAC therapy, including warfarin (international normalized ratio 2-3) or NOACs, is recommended for patients with a CHA2DS2-VASc score ≥2 unless contraindicated.In patients with a CHA2DS2-VASc score of 1, OAC therapy should be preferentially considered, but depending on bleeding risk or patient preferences, antiplatelet therapy or no therapy could be permitted.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Daegu Fatima Hospital, Daegu, Korea.

ABSTRACT
In patients with nonvalvular atrial fibrillation (AF), the risk of stroke varies considerably according to individual clinical status. The CHA2DS2-VASc score is better than the CHADS2 score for identifying truly lower risk patients with AF. With the advent of novel oral anticoagulants (NOACs), the strategy for antithrombotic therapy has undergone significant changes due to its superior efficacy, safety and convenience compared with warfarin. Furthermore, new aspects of antithrombotic therapy and risk assessment of stroke have been revealed: the efficacy of stroke prevention with aspirin is weak, while the risk of major bleeding is not significantly different from that of oral anticoagulant (OAC) therapy, especially in the elderly. Reflecting these pivotal aspects, previous guidelines have been updated in recent years by overseas societies and associations. The Korean Heart Rhythm Society has summarized the new evidence and updated recommendations for stroke prevention of patients with nonvalvular AF. First of all, antithrombotic therapy must be considered carefully and incorporate the clinical characteristics and circumstances of each individual patient, especially with regards to balancing the benefits of stroke prevention with the risk of bleeding, recommending the CHA2DS2-VASc score rather than the CHADS2 score for assessing the risk of stroke, and employing the HAS-BLED score to validate bleeding risk. In patients with truly low risk (lone AF, CHA2DS2-VASc score of 0), no antithrombotic therapy is recommended, whereas OAC therapy, including warfarin (international normalized ratio 2-3) or NOACs, is recommended for patients with a CHA2DS2-VASc score ≥2 unless contraindicated. In patients with a CHA2DS2-VASc score of 1, OAC therapy should be preferentially considered, but depending on bleeding risk or patient preferences, antiplatelet therapy or no therapy could be permitted.

No MeSH data available.


Related in: MedlinePlus

The algorithm of antithrombotic therapy for patients with nonvalvular atrial fibirillation. *Aspirin, clopidogrel or both. Solid-line box: recommended option, dotted-line box: alternative option. NOACs: new oral anticoagulants, VKA: vitamin K antagonist.
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Figure 1: The algorithm of antithrombotic therapy for patients with nonvalvular atrial fibirillation. *Aspirin, clopidogrel or both. Solid-line box: recommended option, dotted-line box: alternative option. NOACs: new oral anticoagulants, VKA: vitamin K antagonist.

Mentions: Antithrombotic therapy plays a very important role in preventing stroke and systemic thromboembolism in patients with nonvavular AF. However, the clinical characteristics of each patient should be carefully considered to maximize the preventative effect and minimize bleeding complications from the drug. The CHA2DS2-VASc score is recommended over the CHADS2 score for assessment of stroke risk. To quantify bleeding risk, the HAS-BLED score is recommended. For patients with nonvalvualr AF and a CHA2DS2-VASc score of 0, antithrombotic therapy is not recommended. OAC therapy is recommended when the CHA2DS2-VASc score is 2 or greater. NOACs should be considered rather than warfarin if there is a possibility of bleeding complications and based upon the results of past studies. For patients with nonvalvualr AF and a CHA2DS2-VASc score of 1, OAC therapy is preferred, but no antithrombotic therapy or treatment with antiplatelet agents can be also considered (Fig. 1).


The Korean Heart Rhythm Society's 2014 Statement on Antithrombotic Therapy for Patients with Nonvalvular Atrial Fibrillation: Korean Heart Rhythm Society.

Jung BC, Kim NH, Nam GB, Park HW, On YK, Lee YS, Lim HE, Joung B, Cha TJ, Hwang GS, Oh S, Kim JS - Korean Circ J (2015)

The algorithm of antithrombotic therapy for patients with nonvalvular atrial fibirillation. *Aspirin, clopidogrel or both. Solid-line box: recommended option, dotted-line box: alternative option. NOACs: new oral anticoagulants, VKA: vitamin K antagonist.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310986&req=5

Figure 1: The algorithm of antithrombotic therapy for patients with nonvalvular atrial fibirillation. *Aspirin, clopidogrel or both. Solid-line box: recommended option, dotted-line box: alternative option. NOACs: new oral anticoagulants, VKA: vitamin K antagonist.
Mentions: Antithrombotic therapy plays a very important role in preventing stroke and systemic thromboembolism in patients with nonvavular AF. However, the clinical characteristics of each patient should be carefully considered to maximize the preventative effect and minimize bleeding complications from the drug. The CHA2DS2-VASc score is recommended over the CHADS2 score for assessment of stroke risk. To quantify bleeding risk, the HAS-BLED score is recommended. For patients with nonvalvualr AF and a CHA2DS2-VASc score of 0, antithrombotic therapy is not recommended. OAC therapy is recommended when the CHA2DS2-VASc score is 2 or greater. NOACs should be considered rather than warfarin if there is a possibility of bleeding complications and based upon the results of past studies. For patients with nonvalvualr AF and a CHA2DS2-VASc score of 1, OAC therapy is preferred, but no antithrombotic therapy or treatment with antiplatelet agents can be also considered (Fig. 1).

Bottom Line: With the advent of novel oral anticoagulants (NOACs), the strategy for antithrombotic therapy has undergone significant changes due to its superior efficacy, safety and convenience compared with warfarin.In patients with truly low risk (lone AF, CHA2DS2-VASc score of 0), no antithrombotic therapy is recommended, whereas OAC therapy, including warfarin (international normalized ratio 2-3) or NOACs, is recommended for patients with a CHA2DS2-VASc score ≥2 unless contraindicated.In patients with a CHA2DS2-VASc score of 1, OAC therapy should be preferentially considered, but depending on bleeding risk or patient preferences, antiplatelet therapy or no therapy could be permitted.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Daegu Fatima Hospital, Daegu, Korea.

ABSTRACT
In patients with nonvalvular atrial fibrillation (AF), the risk of stroke varies considerably according to individual clinical status. The CHA2DS2-VASc score is better than the CHADS2 score for identifying truly lower risk patients with AF. With the advent of novel oral anticoagulants (NOACs), the strategy for antithrombotic therapy has undergone significant changes due to its superior efficacy, safety and convenience compared with warfarin. Furthermore, new aspects of antithrombotic therapy and risk assessment of stroke have been revealed: the efficacy of stroke prevention with aspirin is weak, while the risk of major bleeding is not significantly different from that of oral anticoagulant (OAC) therapy, especially in the elderly. Reflecting these pivotal aspects, previous guidelines have been updated in recent years by overseas societies and associations. The Korean Heart Rhythm Society has summarized the new evidence and updated recommendations for stroke prevention of patients with nonvalvular AF. First of all, antithrombotic therapy must be considered carefully and incorporate the clinical characteristics and circumstances of each individual patient, especially with regards to balancing the benefits of stroke prevention with the risk of bleeding, recommending the CHA2DS2-VASc score rather than the CHADS2 score for assessing the risk of stroke, and employing the HAS-BLED score to validate bleeding risk. In patients with truly low risk (lone AF, CHA2DS2-VASc score of 0), no antithrombotic therapy is recommended, whereas OAC therapy, including warfarin (international normalized ratio 2-3) or NOACs, is recommended for patients with a CHA2DS2-VASc score ≥2 unless contraindicated. In patients with a CHA2DS2-VASc score of 1, OAC therapy should be preferentially considered, but depending on bleeding risk or patient preferences, antiplatelet therapy or no therapy could be permitted.

No MeSH data available.


Related in: MedlinePlus