• The Journal of the Korean dental association
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• v.57 no.10
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• pp.613-622
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• 2019

The vitamin K antagonist (VKA), cumadin, or warfarin, is the only antithrombotic drug that can be orally administered and has excellent effective for decades. However, it is cumbersome to periodically inspect the prothrombin time (PT) order to maintain adequate concentrations that do not cause bleeding, takes a few days to indicate therapeutic effects, gets affected by several factors such as food and drugs etc, and narrow in the therapeutic range. Although recently in development, the non-vitamin K antagonist anticoagulants(NOACs) exhibit a rapid onset of action and have relatively short half- lives compared to Coumadin. Because of these pharmacokinetic properties, it is possible to modify an individual's anticoagulation status quite rapidly, minimizing the period where the anticoagulation activity is therapeutically suboptimal. And the short half -lives of these drug allow for the relatively rapid reduction of their anticoagulation effects. There are currently no published clinical trials specifically assessing the bleeding risks associated with dental procedures for patients taking the NOACs. It is not necessary to interrupt NOAC medication for dental procedures that are likely to cause bleeding, but which have a low risk of bleeding complications. Because the bleeding risk for these procedures is considered to be low, the balance of effects is in favour of continuing the NOAC treatment without modification, to avoid increasing the risk of a thromboembolic event. The patients should be advised to miss(apixaban or dabigatran) or delay(rivaroxaban) a dose of their NOAC prior to dental procedures that are likely to cause bleeding and which have a higher risk of bleeding complications. Because the risk of bleeding complications for these procedures is considered to be higher, the balance effects is in favour of missing or delaying the pretreatment NOAC dose. The interruption is only for a short time to minimize the effect on thromboembolic risk.

• Journal of Chest Surgery
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• v.56 no.2
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• pp.90-98
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• 2023

Background: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Totally thoracoscopic ablation (TTA) is a surgical treatment showing a high success rate as a hybrid procedure with radiofrequency catheter ablation to control AF. This study compared the early complications of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) in patients who underwent TTA. Methods: This single-center retrospective cohort study enrolled patients who underwent planned TTA for AF from February 2012 to October 2020. All patients received postoperative anticoagulation, either with warfarin or a NOAC (apixaban, rivaroxaban, dabigatran, or edoxaban). Propensity score matching was performed for both groups. Early complications were assessed at 12 weeks after TTA and were divided into efficacy and safety outcomes. Both efficacy and safety outcomes were compared in the propensity score-matched groups. Results: Early complications involving efficacy outcomes, such as stroke and transient ischemic attack, were seen in 5 patients in the warfarin group and none in the NOAC group. Although the 2 groups differed in the incidence of efficacy outcomes, it was not statistically significant. In safety outcomes, 11 patients in the warfarin group and 24 patients in the NOAC group had complications, but likewise, the between-group difference was not statistically significant. Conclusion: Among patients who underwent TTA, those who received NOACs had a lower incidence of thromboembolic complications than those who received warfarin; however, both groups showed a similar bleeding complication rate. Using a NOAC after TTA does not reduce efficacy and safety when compared to warfarin.

• International Journal of Arrhythmia
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• v.17 no.1
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• pp.41-45
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• 2016

Atrial fibrillation (AF) can occur in acute coronary syndrome (ACS), which is a serious medical condition and may require the use of antiplatelet agents in addition to anticoagulants for stroke prevention. Recently, novel or non-vitamin K antagonist oral anticoagulants (NOACs) have been increasingly used for stroke prevention in patients with AF instead of traditional OACs. The duration of treatment or treatment with a stepwise approach (e.g. triple, double, or monotherapy) is determined depending on the clinical setting and the balance between the risks of ischemic stroke and bleeding. However, some concerns and controversies in the use of NOACs in patients with AF and ACS need to be addressed. Here, the current management for NOAC therapy in patients with ACS and AF will be reviewed based on recently published guidelines.

• Journal of Korean Medical Science
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• v.33 no.49
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• pp.323.1-323.12
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• 2018

Background: Vitamin K antagonist (VKA) to prevent thromboembolism in non-valvular atrial fibrillation (NVAF) patients has limitations such as drug interaction. This study investigated the clinical characteristics of Korean patients treated with VKA for stroke prevention and assessed quality of VKA therapy and treatment satisfaction. Methods: We conducted a multicenter, prospective, non-interventional study. Patients with $CHADS_2{\geq}1$ and treated with VKA (started within the last 3 months) were enrolled from April 2013 to March 2014. Demographic and clinical features including risk factors of stroke and VKA treatment information was collected at baseline. Treatment patterns and international normalized ratio (INR) level were evaluated during follow-up. Time in therapeutic range (TTR) > 60% indicated well-controlled INR. Treatment satisfaction on the VKA use was measured by Treatment Satisfaction Questionnaire for Medication (TSQM) after 3 months of follow-up. Results: A total of 877 patients (age, 67; male, 60%) were enrolled and followed up for one year. More than half of patients (56%) had $CHADS_2{\geq}2$ and 83.6% had $CHA_2DS_2-VASc{\geq}2$. A total of 852 patients had one or more INR measurement during their follow-up period. Among those patients, 25.5% discontinued VKA treatment during follow-up. Of all patients, 626 patients (73%) had poor-controlled INR (TTR < 60%) measure. Patients' treatment satisfaction measured with TSQM was 55.6 in global satisfaction domain. Conclusion: INR was poorly controlled in Korean NVAF patients treated with VKA. VKA users also showed low treatment satisfaction.

• Journal of the Korea Convergence Society
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• v.12 no.6
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• pp.249-258
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• 2021

The aim of this study was to determine the level of knowledge related to disease in patients with atrial fibrillation. We used the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) and Knowledge of Atrial Fibrillation and Stroke Prevention Questionnaire(KAFSP). A total of 222 AF patients completed the JAKQ and KAFSP. The mean score of the JAKQ and KAFSP 54.7 and 18.5 points, respectively. In general, patients with Atrial fibrillation were well aware that atrial fibrillation causes stroke and that anticoagulants should be taken to prevent blood clots. However, they were not well aware of the precautions for taking anticoagulants, symptoms of atrial fibrillation, and treatment of atrial fibrillation. There was no statistically significant difference in atrial fibrillation knowledge score according to anticoagulants but the degree of knowledge related to VKA was low in patients taking VKA. The both score of JAKQ and KAFSP had significant differences in atrial fibrillation knowledge depending on the level of education. Based on these finding, it is necessary to develop a customized education program in order to improve the knowledge of patients with atrial fibrillation.

• Journal of Yeungnam Medical Science
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• v.37 no.4
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• pp.321-328
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• 2020

Background: This study aimed to investigate the incidences of and risk factors for perioperative events following anticoagulant discontinuation in patients with non-valvular atrial fibrillation (NVAF) undergoing non-cardiac surgery. Methods: A total of 216 consecutive patients who underwent cardiac consultation for suspending perioperative anticoagulants were enrolled. A perioperative event was defined as a composite of thromboembolism and major bleeding. Results: The mean anticoagulant discontinuation duration was 5.7 (±4.2) days and was significantly longer in the warfarin group (p<0.001). Four perioperative thromboembolic (1.9%; three strokes and one systemic embolization) and three major bleeding events (1.4%) were observed. The high CHA₂DS₂-VASc and HAS-BLED scores and a prolonged preoperative anticoagulant discontinuation duration (4.4±2.1 vs. 2.9±1.8 days; p=0.028) were associated with perioperative events, whereas the anticoagulant type (non-vitamin K antagonist oral anticoagulants or warfarin) was not. The best cut-off levels of the HAS-BLED and CHA₂DS₂-VASc scores were 3.5 and 2.5, respectively, and the preoperative anticoagulant discontinuation duration for predicting perioperative events was 2.5 days. Significant differences in the perioperative event rates were observed among the four risk groups categorized according to the sum of these values: risk 0, 0%; risk 1, 0%; risk 2, 5.9%; and risk 3, 50.0% (p<0.001). Multivariate logistic regression analysis showed that the HAS-BLED score was an independent predictor for perioperative events. Conclusion: Thromboembolic events and major bleeding are not uncommon during perioperative anticoagulant discontinuation in patients with NVAF, and interrupted anticoagulation strategies are needed to minimize these.