The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Application of New Oral Anticoagulants: Prevention of Stroke in Patients with Nonvalvular Atrial Fibrillation

새로운 항응고제의 임상적 적용: 비판막성 심방세동 환자에서 뇌졸중의 예방을 위한 새로운 항응고제의 사용을 중심으로

  • Kim, Dongmin (Department of Internal Medicine, Dankook University College of Medicine) ;
  • Lee, Myung-Yong (Department of Internal Medicine, Dankook University College of Medicine)
  • 김동민 (단국대학교 의과대학 내과학교실) ;
  • 이명용 (단국대학교 의과대학 내과학교실)
  • Published : 2014.07.01
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Abstract

Only anticoagulation has been shown to reduce atrial fibrillation-related deaths. Vitamin K antagonists are difficult to use due to their narrow therapeutic range, unpredictable response, requirement for frequent coagulation monitoring, frequent dose adjustment, slow onset-offset, and numerous drug-drug and drug-food interactions. New oral anticoagulants (NOACs), such as dabigatran, rivaroxaban, and apixaban have been developed and are available in Korea, and edoxaban was shown to be effective and safe, also. NOACs showed better pharmacodynamics with predictable serum concentrations and effects, and no requirement for coagulation monitoring. These drugs have been shown to be more effective and safer than warfarin for prevention of stroke and systemic thromboembolism in patients with nonvalvular atrial fibrillation. Broad, appropriate, and aggressive use of NOACs would improve the results of treatment in patients with nonvalvular atrial fibrillation in Korea.

비판막성 심방세동의 장기치료에서 사망률을 낮출 수 있는 치료는 현재까지 항응고 치료가 유일하다. 현재까지 사용하고 있는 와파린은 좁은 안전역, 잦은 검사의 필요성, 예측되지 않는 약물반응, 약물 상호작용, 음식 상호작용, 느린 효과의 발현 및 소실 등의 문제로 인하여 사용이 어려운 약물이다. 최근 개발된 새로운 기전의 항응고제를 new oral anticoagulant(NOAC)이라고 하며 dabigatran, rivaroxaban, apixaban 등이 국내에서 이미 사용이 가능하며 edoxaban이 최근 좋은 임상 결과를 발표하였다. NOAC은 빠른 효과를 보이고 약을 끊었을 때 효과가 빠르게 소실이 되며 정해진 용량을 복용하였을 때 혈중 약물 농도를 잘 예측할 수 있으므로 혈액 검사로 효과를 확인할 필요가 없으며 약물 및 음식과의 상호작용이 매우 적은 장점이 있으면서 뇌졸중의 예방 효과는 와파린과 비교하여 비슷하거나 더욱 효과적이며 합병증에 있어서도 와파린과 비슷하거나 오히려 우수하다. 적극적인 NOAC의 사용으로 비판막성 심방세동 환자의 치료 결과가 호전될 것으로 기대된다.

Keywords

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