First AF episode일지라도 systemic embolization(warfarin or NOAC)의 필요성을 평가(CHA2DS2-VASc score을 사용)해야 합니다.
Prevention of systemic embolization
Every patient with AF should be evaluated for the need of antithrombotic therapy to prevent systemic embolization even for the first AF episode. This is accomplished by use of the CHA2DS2-VASc score(table). Patients who require antithrombotic therapy include those in whom cardioversion (whether electrically or pharmacologically) to sinus rhythm is being considered (regardless of the CHA2DS2-VASc score or method of cardioversion [electrical or pharmacologic]) and those who meet criteria for long-term anticoagulation. All patients whose risk of embolization exceeds the risk of bleeding are candidates for long-term antithrombotic therapy.
Clinical risk factors for stroke, transient ischemic attack, and systemic embolism in the CHA2DS2-VASc score
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(A) The risk factor-based approach expressed as a point based scoring system, with the acronym CHA2DS2-VASc (NOTE: maximum score is 9 since age may contribute 0, 1, or 2 points) |
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CHA2DS2-VASc risk factor |
Points |
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Congestive heart failure Signs/symptoms of heart failure or objective evidence of reduced left-ventricular ejection fraction |
+1 |
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Hypertension Resting blood pressure >140/90 mmHg on at least two occasions or current antihypertensive treatment |
+1 |
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Age 75 years or older |
+2 |
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Diabetes mellitus Fasting glucose >125 mg/dL (7 mmol/L) or treatment with oral hypoglycaemic agent and/or insulin |
+1 |
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Previous stroke, transient ischaemic attack, or thromboembolism |
+2 |
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Vascular disease Previous myocardial infarction, peripheral artery disease, or aortic plaque |
+1 |
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Age 65-74 years |
+1 |
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Sex category (female) |
+1 |
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(B) Adjusted stroke rate according to CHA2DS2-VASc score |
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CHA2DS2-VASc score |
Patients (n = 73,538) |
Stroke and thromboembolism event rate at one-year follow-up (%) |
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0 |
6369 |
0.78 |
|
1 |
8203 |
2.01 |
|
2 |
12,771 |
3.71 |
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3 |
17,371 |
5.92 |
|
4 |
13,887 |
9.27 |
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5 |
8942 |
15.26 |
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6 |
4244 |
19.74 |
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7 |
1420 |
21.50 |
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8 |
285 |
22.38 |
|
9 |
46 |
23.64 |
CHA2DS2-VASc: Congestive heart failure, Hypertension, Age (≥75) (doubled), Diabetes, Stroke (doubled), Vascular disease, Age (65-74), Sex.
Part A from: Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016; 18(11):1609-1678. By permission of Oxford University Press on behalf of the European Society of Cardiology. Copyright © 2016 Oxford University Press. Available at: www.escardio.org/.
REF. UpToDate 2019.07.17
