EndoTODAY 이준행

[20120323. Complications of EMR/ESD (78): Bleeding (42) - warfarin (10) low molecular weight heparin (3)]

간혹 몇몇 신경과 의사들은 LMWH에 대하여 우려의 시각을 보이기도 합니다 (Moonis 2002). 일부를 옮깁니다.

While the role of oral anticoagulants is clearly established in the prevention of recurrent cardioembolic stroke, anticoagulation with parenteral unfractionated intravenous heaptin (UFIH) and low molecular weight heparin (LMWH) for acute ischemic stroke remains an area of ongoing controversy.

LMWH cannot be recommended in any type of acute ischemic stroke populations to prevent recurrent stroke or to improve stoke outcome.

UFIH is not generally indicated in most patients with an ischemic stroke. However, in certain cardioembolic stroke subgroups, especially AF, presenting with additional risk factors such as mural thrombi and/or recent AMI, the subsequent stroke risk seems to be high. These patients may benefit from UFIH and ...

In some situations in which anticoagulation is required for the long term (eg, patients with AF), initiation of treatment with warfarin early after stroke onset is likely safer than beginning treatment with UFIH and switching to warfarin. This would abrogate the associated risk of major bleeding side effects associated with the use of UFIH.

[참고 자료]

1) EndoTODAY 와파린

2) 항혈소판제 Antiplatelets - 내시경 혹은 조직검사 전 아스피린, 항혈소판제를 끊을 것인가?

3) 새로운 항응고제 New oral anticoagulant (NOAC)

4) 항혈소판제, 항응고제 중단 지침 (삼성서울병원 2011)