The Korean heart rhythm society's 2014 statement on antithrombotic therapy for patients with nonvalvular atrial fibrillation: Korean heart rhythm society

Byung Chun Jung, Nam Ho Kim, Gi Byung Nam, Hyung Wook Park, Young Keun On, Young Soo Lee, Hong Euy Lim, Boyoung Joung, Tae Joon Cha, Gyo Seung Hwang, Seil Oh, June Soo Kim

Research output: Contribution to journalReview article

26 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)9-19
Number of pages11
JournalKorean Circulation Journal
Volume45
Issue number1
DOIs
Publication statusPublished - 2015 Jan 1

Fingerprint

Atrial Fibrillation
Anticoagulants
Stroke
Hemorrhage
Therapeutics
Warfarin
International Normalized Ratio
Patient Preference
Aspirin
Guidelines
Safety

Keywords

  • Anticoagulant
  • Antithrombotic agent
  • Atrial fibrillation

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

The Korean heart rhythm society's 2014 statement on antithrombotic therapy for patients with nonvalvular atrial fibrillation : Korean heart rhythm society. / Jung, Byung Chun; Kim, Nam Ho; Nam, Gi Byung; Park, Hyung Wook; On, Young Keun; Lee, Young Soo; Lim, Hong Euy; Joung, Boyoung; Cha, Tae Joon; Hwang, Gyo Seung; Oh, Seil; Kim, June Soo.

In: Korean Circulation Journal, Vol. 45, No. 1, 01.01.2015, p. 9-19.

Research output: Contribution to journalReview article

Jung, BC, Kim, NH, Nam, GB, Park, HW, On, YK, Lee, YS, Lim, HE, Joung, B, Cha, TJ, Hwang, GS, Oh, S & Kim, JS 2015, 'The Korean heart rhythm society's 2014 statement on antithrombotic therapy for patients with nonvalvular atrial fibrillation: Korean heart rhythm society', Korean Circulation Journal, vol. 45, no. 1, pp. 9-19. https://doi.org/10.4070/kcj.2015.45.1.9
Jung, Byung Chun ; Kim, Nam Ho ; Nam, Gi Byung ; Park, Hyung Wook ; On, Young Keun ; Lee, Young Soo ; Lim, Hong Euy ; Joung, Boyoung ; Cha, Tae Joon ; Hwang, Gyo Seung ; Oh, Seil ; Kim, June Soo. / The Korean heart rhythm society's 2014 statement on antithrombotic therapy for patients with nonvalvular atrial fibrillation : Korean heart rhythm society. In: Korean Circulation Journal. 2015 ; Vol. 45, No. 1. pp. 9-19.
@article{ab0699cc865e4a31aca3d9ce1ff41027,
title = "The Korean heart rhythm society's 2014 statement on antithrombotic therapy for patients with nonvalvular atrial fibrillation: Korean heart rhythm society",
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.",
keywords = "Anticoagulant, Antithrombotic agent, Atrial fibrillation",
author = "Jung, {Byung Chun} and Kim, {Nam Ho} and Nam, {Gi Byung} and Park, {Hyung Wook} and On, {Young Keun} and Lee, {Young Soo} and Lim, {Hong Euy} and Boyoung Joung and Cha, {Tae Joon} and Hwang, {Gyo Seung} and Seil Oh and Kim, {June Soo}",
year = "2015",
month = "1",
day = "1",
doi = "10.4070/kcj.2015.45.1.9",
language = "English",
volume = "45",
pages = "9--19",
journal = "Korean Circulation Journal",
issn = "1738-5520",
publisher = "Korean Society of Circulation",
number = "1",

}

TY - JOUR

T1 - The Korean heart rhythm society's 2014 statement on antithrombotic therapy for patients with nonvalvular atrial fibrillation

T2 - Korean heart rhythm society

AU - Jung, Byung Chun

AU - Kim, Nam Ho

AU - Nam, Gi Byung

AU - Park, Hyung Wook

AU - On, Young Keun

AU - Lee, Young Soo

AU - Lim, Hong Euy

AU - Joung, Boyoung

AU - Cha, Tae Joon

AU - Hwang, Gyo Seung

AU - Oh, Seil

AU - Kim, June Soo

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

AB - 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.

KW - Anticoagulant

KW - Antithrombotic agent

KW - Atrial fibrillation

UR - http://www.scopus.com/inward/record.url?scp=84921867375&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921867375&partnerID=8YFLogxK

U2 - 10.4070/kcj.2015.45.1.9

DO - 10.4070/kcj.2015.45.1.9

M3 - Review article

AN - SCOPUS:84921867375

VL - 45

SP - 9

EP - 19

JO - Korean Circulation Journal

JF - Korean Circulation Journal

SN - 1738-5520

IS - 1

ER -