EndoTODAY | EndoATLAS | OPD

Parasite | Eso | Sto | Cancer | ESD

Boxim | DEX | Sono | Schedule

Home | Recent | Blog | Links

EndoTODAY ³»½Ã°æ ±³½Ç


[NOAC (new oral anticoagulant) »õ·Î¿î Ç×ÀÀ°íÁ¦ = DOAC (direct oral anticoagulant)] - ðû

1. Áõ·Ê : NOAC Áß´Ü ÈÄ CVA

2. NOAC (= DOAC)À̶õ ¾î¶² ¾àÀΰ¡?

3. NOAC »ç¿ë ȯÀÚÀÇ ³»½Ã°æ ½Ã¼ú

4. Warfarin°ú NOACÀÇ GI bleeding risk

5. Guidelines and reviews

6. FAQ

7. References

PDF (https://www.e-ce.org)


1. Áõ·Ê : NOAC Áß´Ü ÈÄ CVA

À§,´ëÀå³»½Ã°æÀ» À§ÇÏ¿© edoxabanÀ» 7ÀÏ ²÷°í °ËÁøÀ» ¹ÞÀº ÈÄ ´çÀÏ Áý¿¡¼­ ½ÉÇÑ CVA°¡ ¹ß»ýÇÏ¿© Àα٠º´¿ø¿¡¼­ angiographic thrombectomy¸¦ ¹ÞÀº ȯÀÚ°¡ À§¼±Á¾ ³»½Ã°æ Ä¡·á¸¦ À§ÇÏ¿© ¹æ¹®Çϼ̽À´Ï´Ù.

ÀϹÝÀûÀÎ À§³»½Ã°æ°ú ´ëÀå³»½Ã°æÀº NOACÀ» Àü³¯±îÁö µå½Ã°í ´ÙÀ½ ³¯ ¾à¹°ÀÇ trough level¿¡¼­ ½Ã¼úÀ» ÇÕ´Ï´Ù. ÇÏ·ç ÇÑ ¹ø µå½Ã°í °è½Å ºÐÀÇ °æ¿ì ±×³É Æò¼Òó·³ ¾àÀ» µå½Ã°í ³»½Ã°æ ´çÀÏ ¾ÆÄ§¿¡¸¸ ¾à(NOAC)À» µå½ÃÁö ¸»¶ó°í ÇÏ¸é µË´Ï´Ù. °ËÁøµµ ¸¶Âù°¡ÁöÀÔ´Ï´Ù. ¸¶Áö¸· dose 24½Ã°£¿¡ °Ë»ç¸¦ ÇÏ´Â °ÍÀÌÁö¿ä. ´Ù¸¸ ESD ó·³ ÃâÇ÷ À§ÇèÀÌ ¸Å¿ì ³ôÀº ½Ã¼úÀº ¸¶Áö¸· ¾à º¹¿ë 48 ½Ã°£À» ¼±ÅÃÇϱ⵵ ÇÕ´Ï´Ù. ½Ã¼ú Àü³¯ ÇϷ縸 ¾àÀ» ²÷´Â °ÍÀÌÁö¿ä. 72½Ã°£ ÀÌ»ó Áß´Ü ½Ã ½ÉÇ÷°ü°è À§ÇèÀÌ ±Þ°ÝÈ÷ Áõ°¡ÇÕ´Ï´Ù.

±×·±µ¥, ÀÌ È¯ÀÚ´Â ³»½Ã°æ ½Ã¼ú 7ÀÏ ÀüºÎÅÍ ¾àÀ» ¸ÔÁö ¾Ê°í °ËÁøÀ» ¹Þ¾Ò°í °á±¹ CVA°¡ ¹ß»ýÇÏ¿© Å« °íºñ¸¦ ¸Â¾Ò´ø °ÍÀÔ´Ï´Ù. ¾ÈŸ±õ½À´Ï´Ù.

¿Ö ±×·¸°Ô À§ÇèÇÑ ÀÏÀ» Çϼ̴ÂÁö, NOAC¸¦ 7ÀÏ ²÷´Â °ÍÀº °ÅÀÇ ÀÚ»ìÇàÀ§¿Í ´Ù¸§¾ø´Ù´Â °ÍÀ» ¸ð¸£¼Ì´ÂÁö ¹°¾îº¸¾Ò½À´Ï´Ù. ´äº¯Àº ¾Ö¸ÅÇß½À´Ï´Ù. °ËÁø ±â°ü¿¡¼­ 5ÀÏ ²÷µµ·Ï Çß´Ù´Â °ÍÀÎÁö, ¾Æ´Ï¸é ȯÀÚ°¡ ±×·¸°Ô ÀÌÇØÇß´Ù´Â °ÍÀÎÁö Á¤È®È÷ ¾Ë±â ¾î·Á¿ü½À´Ï´Ù. °Ô´Ù°¡ ȯÀÚ´Â ±×º¸´Ù ´õ ¿À·¡ ²÷À¸¼Ì½À´Ï´Ù. ȯÀÚ´Â ¾Æ½ºÇǸ°°ú NOACÀÇ Â÷À̸¦ Àß ¸ð¸£´Â µí Çß½À´Ï´Ù. (¾Æ½ºÇǸ°À» ÀÏÁÖÀÏ ²÷¾úÀ¸´Ï NOACµµ ÀÏÁÖÀÏ ²÷Àº °ÍÀÔ´Ï´Ù. Oh My God!)

ÃÖ±Ù¿¡´Â À§³»½Ã°æÀ̳ª ´ëÀå³»½Ã°æ Àü ¾Æ½ºÇǸ°Àº ²÷Áö ¾Êµµ·Ï ±ÇÇϰí ÀÖ½À´Ï´Ù. Ȥ½Ã ²÷´õ¶óµµ 2-3ÀÏ Á¤µµ¸¸ ²÷°í ÀÖ½À´Ï´Ù. ±× ÀÌ»ó ²÷À¸¸é ¸Å¿ì À§ÇèÇϱ⠶§¹®ÀÔ´Ï´Ù. ±×·±µ¥ ȯÀÚ³ª Àǻ糪 °ú°ÅÀÇ ¹æ½Ä(1ÁÖÀÏ Áß´Ü)À» ¾ÆÁ÷ ¹Ù²ÙÁö ¸øÇÏ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ¾ÈŸ±õ½À´Ï´Ù.

¼øÈ¯±â³»°ú¿Í ½Å°æ°ú¿¡ ¹®ÀÇÇÏ¿´½À´Ï´Ù. ¼øÈ¯±â³»°ú¿¡¼­´Â '½Ã¼ú 2ÀÏ Àü Áß´Ü'À» ±ÇÇÏ¿´½À´Ï´Ù. ½Å°æ°ú¿¡¼­´Â '2Àϰ£¸¸ Áß´Ü ÈÄ ½Ã¼ú'À» ±ÇÇÏ¿´½À´Ï´Ù. °°Àº ¸»Àϱî¿ä, ´Ù¸¥ ¸»Àϱî¿ä? '½Ã¼ú 2ÀÏ Àü Áß´Ü'À̶ó°í ¼³¸íÀ» ÇÑ´Ù¸é ȯÀÚµéÀº º¸Åë 72½Ã°£ ¾àÀ» ²÷½À´Ï´Ù. ¸¸¾à ¼ö¿äÀÏ¿¡ ESD¸¦ ÇÑ´Ù¸é º¸Åë ÀÏ¿äÀϱîÁö ¾àÀ» µå½Ã°í, ¿ù¿äÀÏ, È­¿äÀÏÀº ¾àÀ» ¸ÔÁö ¾ÊÀ» °ÍÀÔ´Ï´Ù. ±×·¯¸é ¼ö¿äÀÏ ¿ÀÀü ½Ã¼úÀº ¸¶Áö¸· NOAC º¹¿ë 72½Ã°£ Èİ¡ µË´Ï´Ù. »ç½Ç Àü¹®°¡°¡ ¿øÇß´ø °ÍÀº ¸¶Áö¸· º¹¾à 48½Ã°£ ½ÃÁ¡¿¡ ½Ã¼úÀ» Ç϶ó´Â °ÍÀ̾ú´Âµ¥µµ ¸»ÀÔ´Ï´Ù. ÀÌ·± ÀÌÀ¯·Î ¸¶Áö¸· º¹¾à 48½Ã°£ ÈÄ ½Ã¼úÀ» ÇϰíÀÚ ÇÑ´Ù¸é '½Ã¼ú 2ÀÏ Àü Áß´Ü'À̶ó°í ¼³¸íÇÏ¸é ¾È µË´Ï´Ù. '½Ã¼ú Àü³¯¸¸ ¾àÀ» µå½ÃÁö ¸¶¼¼¿ä'¶ó°í ¼³¸íÇØ¾ß ÇÕ´Ï´Ù. '½Ã¼ú 2ÀÏ Àü Áß´Ü'À̶ó°í ¼³¸íÇÏ¸é ¸¶Áö¸· dose 72½Ã°£ ½Ã¼úÀÌ µÇ°í ¸¿´Ï´Ù. ¿ë¾î ¼±ÅÃÀº ÀÌ·¸°Ô ¾î·Á¿î À̽´ÀÔ´Ï´Ù.

ÀÌ¿Í °°Àº È¥¼±Àº ¿µ¾î¿¡¼­µµ ¸¶Âù°¡ÁöÀÔ´Ï´Ù. ¾Æ½Ã¾Æ ÅÂÆò¾ç °¡À̵å¶óÀÎ(Gut 2018)¿¡µµ "Withhold DOACs 2 days before"¶ó°í Ç¥ÇöµÈ ºÎºÐ°ú "withholding DOACs (at least) 48hours before the procedure"¶ó°í Ç¥ÇöµÈ ºÎºÐÀÌ È¥ÀçµÇ¾î ÀÖ½À´Ï´Ù. Native speaker°¡ ¾Æ´Ñ Àú¿¡°Ô µÎ ¿µ¾î Ç¥ÇöÀÌ ´Ù¸£°Ô µé·È½À´Ï´Ù. 'Withhold DOACs 2 days before'´Â 72½Ã°£ ²÷À¸¶ó´Â ¸»À̰í 'withholding DOACs (at least) 48hours before the procedure'´Â 48½Ã°£ ²÷À¸¶ó´Â ¸» ¾Æ´Ñ°¡¿ä? Ȥ½Ã Á¦°¡ ¿ÀÇØÇϰí ÀÖ´Â °ÍÀԴϱî? ¾î¶»°Ô °¡À̵å¶óÀÎ ÀúÀÚµéÀÌ ÀÌ·¸°Ô ¸ðÈ£ÇÑ ¿ë¾î¸¦ ¾µ ¼ö ÀÖ´Â °ÍÀÌÁö¿ä? ÀÌ·¯ÇÑ È¥¼±À» ¸·±â À§Çؼ­´Â ¸¶Áö¸· dose 48½Ã°£¿¡ ½Ã¼úÀ» ÇϰíÀÚ ÇÑ´Ù¸é '½Ã¼ú Àü³¯¸¸ ¾àÀ» µå½ÃÁö ¸¶¼¼¿ä'¶ó°í ¼³¸íÇØ¾ß ÇÕ´Ï´Ù. ¿µ¾î·Î´Â 'skip taking DOAC for one day before the procedure' Á¤µµ°¡ µÉ °ÍÀÔ´Ï´Ù. ±×·±µ¥ ¾î¶² ¿µ¾î °¡À̵å¶óÀεµ ÀÌ·± Ç¥ÇöÀ» ¾²°í ÀÖ´Â °÷Àº ¾ø´Â °Í °°½À´Ï´Ù. ´Ù¸¸ 2016³â À¯·´ °¡À̵å¶óÀο¡ "For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ¡Ã 48 hours before the procedure."¶ó°í µÇ¾î ÀÖÀ» »ÓÀÔ´Ï´Ù. ¿äÄÁµ¥ ¸ÅÀÏ ¾ÆÄ§ º¹¿ëÇÏ´Â ¾àÀÇ °æ¿ì ÇÑ ¹ø ¸ÔÁö ¾Ê¾Æ¾ß 48½Ã°£ ²÷´Â °ÍÀÔ´Ï´Ù. µÎ ¹ø ¸ÔÁö ¾ÊÀ¸¸é 72½Ã°£ ²÷´Â °ÍÀÔ´Ï´Ù.

¾Æ½Ã¾ÆÆÛ½ÃÇÈ °¡À̵å¶óÀÎ (Gut 2018) NOAC ºÎºÐ
35. We recommend withholding DOACs at least 48hours before the procedure.
36. We do not recommend bridging anticoagulation.
37. We recommend resuming DOACs after adequate haemostasis has been achieved.

´ëºÎºÐÀÇ »óȲ¿¡¼­´Â NOACÀ» 48½Ã°£ ²÷´Â °Í°ú 72½Ã°£ ²÷´Â °ÍÀº Å« Â÷À̰¡ ¾øÀ» °ÍÀÔ´Ï´Ù. ±×·¯³ª NOACÀ» ²÷°í ½ÉÇÑ CVA°¡ »ý°å´ø ȯÀÚ¿¡¼­ 48½Ã°£°ú 72½Ã°£Àº ÀüÇô ´Ù¸¥ À̾߱âÀÔ´Ï´Ù. ±×·¡¼­ Àú´Â ¸Å¿ì ±¸Ã¼ÀûÀ¸·Î ¼³¸íÇÏ¿´½À´Ï´Ù. "16ÀϱîÁö´Â ¾àÀ» µå½Ê½Ã¿ä. 17ÀÏ ÇϷ縸 µå½ÃÁö ¸¶¼¼¿ä. 18ÀÏ ¿ÀÀü ½Ã¼úÇϰí 18ÀÏ ¿ÀÈĺÎÅÍ ´Ù½Ã º¹¿ëÅä·Ï Á¶Ã³ÇÒ °ÍÀÔ´Ï´Ù"¶ó°í Àý´ë·Î Çò°¥¸®Áö ¾Êµµ·Ï ¼³¸íÇÏ¿´½À´Ï´Ù.

ESD Àü NOACÀ» 24½Ã°£ ²÷°í ½Ã¼úÇÏ¸é ¾È µÈ´Ù´Â ¹ýµµ ¾ø½À´Ï´Ù. ¿©ÇÏÆ° consult ´äº¯À» °í·ÁÇÏ¿© 48½Ã°£ Áß´ÜÀ» °áÁ¤ÇÏ¿´°í À̸¦ Á¤È®È÷ ¼³¸íµå·È½À´Ï´Ù. ESD¸¦ ¿ÀÀü¿¡ ÇÏ¿´°í ´ÊÀº ¿ÀÈÄ¿¡ NOAC(edoxaban)À» ÀçÅõ¾à ÇÏ¿´½À´Ï´Ù.


ESD: Tubular adenoma with high grade dysplasia
1. Location : antrum, lesser curvature
2. Gross type : flat and depressed
3. Size of adenoma : (1) longest diameter, 8 mm (2) vertical diameter, 5 mm
4. Resection margin : negative resection margins(N)

´Ù½Ã ÇÑ ¹ø °­Á¶ÇÕ´Ï´Ù. ÇÑ ¹ø ¸ÔÁö ¾Ê¾Æ¾ß 48½Ã°£ ²÷´Â °ÍÀÔ´Ï´Ù. µÎ ¹ø ¸ÔÁö ¾ÊÀ¸¸é 72½Ã°£ÀÔ´Ï´Ù.


2. NOAC (= DOAC)À̶õ ¾î¶² ¾àÀΰ¡?

Vitamin K antagonistÀÎ warfarin°ú ±¸ºÐµÇ´Â »õ·Î¿î Ç×ÀÀ°íÁ¦µéÀ» NOAC(new oral anticoagulant)À̶ó°í ÇÕ´Ï´Ù. Factor Xa, IIa µîÀ» targetÀ¸·Î ÇÏ´Â dabigatran, rivaroxaban, apixaban µîÀÌ ´ëÇ¥ÀûÀÔ´Ï´Ù. NOACÀº non-valvular AF ȯÀÚ¿¡¼­ È¿°ú°¡ ÀÔÁõµÇ¾î ÀÖ½À´Ï´Ù.

2013³â 11¿ù 10ÀÏ ´ëÀüÄÁº¥¼Ç¼¾ÅÍ¿¡¼­ ¿­¸° ´ëÀüÃæ³² °³¿ø³»°úÀÇ»çȸ Ãß°èÇмú´ëȸ¿¡¼­ '¼­¿ï´ëÇб³ ºÐ´çº´¿ø ¼øÈ¯±â³»°ú ¿ÀÀÏ¿µ ±³¼öÀÇ '³õÄ¡¸é ¾ÈµÇ´Â 7°¡Áö ½ÉÀüµµ' °­ÀǸ¦ µé¾ú½À´Ï´Ù. »õ·Î¿î Ç×ÀÀ°íÁ¦¿¡ ´ëÇÑ °£´ÜÇÑ ¼Ò°³°¡ ÀÖ¾ú½À´Ï´Ù.

NOACÀÇ ¿ÍÆÄ¸° ´ëºñ ÀåÁ¡Àº ´ÙÀ½°ú °°½À´Ï´Ù. (1) more predictable half-life/elimination, (2) predictable effect without need for monitoring, (3) improved efficacy/safety ratio. µû¶ó¼­ NOACÀº INR monitoringÀÌ ÇÊ¿ä¾ø°í, peak effect°¡ 2-4½Ã°£¿¡ ³ªÅ¸³³´Ï´Ù. ´ÜÁ¡Àº ÇØµ¶Á¦°¡ ¾ø´Ù´Â Á¡ÀÔ´Ï´Ù (´Ü 2015³â¿¡ ¹Ì±¹ FDA¿¡¼­ idarucizumab (Praxbind)°¡ dabigatran reversal agent·Î Çã°¡¹Þ¾Ò½À´Ï´Ù).

ÀÚ·áÁ¦°ø: ½Å¿î°Ç

±Ý±âÁõÀº (1) valvular atrial fibrillation, (2) mechanical valve, (3) ESRDÀÔ´Ï´Ù.

Dabigatran 150mgÀº À§ÀåÀå¾Ö¿Í À§Àå°ü ÃâÇ÷ÀÌ ¸¹´Ù´Â Á¡ÀÌ ¹®Á¦ÀÔ´Ï´Ù (modest but significantly higher risk). ´Ù¸¸ ÃÖ±Ù postmarketing survey¿¡¼­´Â ÃâÇ÷ À§ÇèÀÌ ³ôÁö ¾Ê´Ù´Â ÀÚ·á°¡ ÀÖ½À´Ï´Ù.

ÀÚ·áÁ¦°ø: ½Å¿î°Ç

Rivaroxaban°ú apixabanÀÇ ÃâÇ÷À§ÇèÀº ÀüüÀûÀ¸·Î´Â ¿ÍÆÄ¸°°ú ºñ½ÁÇÕ´Ï´Ù. ±×·¯³ª rivaroxabanÀº ÀüüÀûÀ¸·Î´Â ¿ÍÆÄ¸°°ú ºñ½ÁÇÏÁö¸¸ GI bleedingÀº ¿ÍÆÄ¸°º¸´Ù ¸¹´Ù´Â NEJM ÀÚ·á°¡ ÀÖ½À´Ï´Ù.

ÀÚ·áÁ¦°ø: ½Å¿î°Ç

Dabigatran overdose°¡ ÀǽɵǸé aPPT¸¦ ÃøÁ¤Çϰí, rivaroxaban°ú apixaban overdose°¡ ÀǽɵǸé PT¸¦ ÃøÁ¤ÇÕ´Ï´Ù. NOAC »ç¿ë ȯÀÚ°¡ ÃâÇ÷·Î ¿À¸é ÀÏ´Ü supportive care¸¦ Çϰí, ÃâÇ÷¾çÀÌ ¸¹À¸¸é FFPÀ» ¾µ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ´Ù¸¸ dabigatranÀº Ç÷¾×Åõ¼®À¸·Î ÀÀ°í´É·ÂÀ» ȸº¹½Ãų ¼ö ÀÖ½À´Ï´Ù.

NOAC ȯÀÚ¿¡¼­ ÃâÇ÷·üÀÌ ³ôÁö ¾Ê´Ù´Â º¸°íµµ À־ (Cangemi DJ. Am J Gastroenterol 2017), ÀÌ À̽´´Â ¾ÆÁ÷ °á·ÐÀÌ ³ªÁö ¾ÊÀº °ÍÀ» º¸´Â ÆíÀÌ ¾ÈÀüÇÒ °Í °°½À´Ï´Ù.


3. NOAC »ç¿ë ȯÀÚÀÇ ³»½Ã°æ ½Ã¼ú

NOACÀº 48½Ã°£ Á¤µµ ²÷À¸¸é ´ëºÎºÐÀÇ °íÀ§Çè ½Ã¼úÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù. (1ÀÏ 1ȸ ¸Ô´Â ¾àÀº ÇÏ·ç ¾È ¸ÔÀ¸¸é 48½Ã°£ ²÷´Â ¼ÀÀÔ´Ï´Ù (Áõ·Ê ÂüÁ¶). ´Ü ½ÅÀå±â´ÉÀÌ ³ª»Û ȯÀÚ¿¡¼­ dabigatranÀº Á¶±Ý ´õ ¿À·¡ ²÷¾î¾ß ÇÕ´Ï´Ù.


2015³â 10¿ù Digestive Endoscopy¿¡ Ç×ÀÀ°íÁ¦ »ç¿ëȯÀÚÀÇ ³»½Ã°æ¿¡ ´ëÇÑ Á¾¼³ÀÌ ½Ç·È½À´Ï´Ù (Ono S. Digest Endosc 2015). NOAC¿¡ ´ëÇÑ °£°áÇÑ tableÀÌ ÀÖ¾î ¼Ò°³ÇÕ´Ï´Ù. Morning dose¸¸ skipÇϰí low risk procedure¸¦ ÇÒ ¼ö ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù. Áï ³»½Ã°æ °Ë»çÀÏ ¾ÆÄ§¿¡ ±Ý½ÄÀ» Çϸ鼭 NOACµµ µå½ÃÁö ¾Ê¾Ò´Ù¸é Á¶Á÷°Ë»ç¸¦ ÇÒ ¼ö ÀÖ½À´Ï´Ù. Àü³¯±îÁö NOACÀ» µå¼Ì´Ù´Â ÀÌÀ¯·Î Á¶Á÷°Ë»ç°¡ ÇÊ¿äÇѵ¥ Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾ÊÀ¸¸é ºÎÀûÀýÇÑ °Ë»ç·Î Æò°¡µÉ ¼ö ÀÖ½À´Ï´Ù.


NOAC µå½Ã´Â ȯÀÚÀÇ GI safety profile¿¡ ´ëÇÑ large population-based study°¡ ¹ßÇ¥µÇ¾ú½À´Ï´Ù (Abraham NS. Gastroenterology 2016 - Epub). Áï apixabanÀÌ °¡Àå ¾ÈÀüÇϰí rivaroxabanÀÌ °¡Àå À§ÇèÇÏ´Ù´Â °ÍÀÔ´Ï´Ù. Apixaban (»ó´ëÀûÀ¸·Î ¾ÈÀü) > Dabigatran > Rivaroxaban (»ó´ëÀûÀ¸·Î À§Çè). Áï ¾ËÆÄºª ¼ø¼­ÀÔ´Ï´Ù.

CONCLUSIONS: In a population-based study of patients receiving DOAC agents, we found apixaban had the most favorable GI safety profile and rivaroxaban least favorable. GI bleeding events among patient taking DOACs increased with age; the risk was greatest among persons ¡Ã75 years old. Apixaban had the most favorable GI safety profile among all age-groups.


NOACÀ» ²÷°í ½Ã¼ú ÇÑ ÈÄ ¾ðÁ¦ºÎÅÍ ´Ù½Ã NOACÀ» µå¼Åµµ ÁÁÀ»Áö´Â Á¤ÇØÁø °ÍÀº ¾ø½À´Ï´Ù. ½Ã¼ú ÈÄ ÃâÇ÷ÀÌ ¾øÀ¸¸é °¡±ÞÀû ÀÏÂï ´Ù½Ã ½ÃÀÛÇÑ´Ù´Â °³·«ÀûÀÎ »ý°¢¸¸ ÀÖÁö¸¸...

Rivaroxaban Àá½Ã Áß´Ü ÈÄ Àúµµ¼±Á¾¿¡ ´ëÇÑ ¼ÒÀÛ¼ú(APC ablation)À» ¹ÞÀº ¼öÀÏ ÈÄ rivaroxaban À纹¿ëÇÏ°í ¹ß»ýÇÑ ÃâÇ÷


Dabigatran »ç¿ëȯÀÚÀÇ ³»½Ã°æ ½Ã¼ú¿¡ ´ëÇÏ¿© ÀÇ·Ú¸¦ ÇÏ¿´´Âµ¥ ¾Æ·¡¿Í °°Àº ´äº¯À» ¹Þ¾Ò½À´Ï´Ù.

³»½Ã°æ Ä¡·á¿¡ ´ëÇÏ¿© ¹®ÀÇÇÏ¿´´Âµ¥ ´ë±Ô¸ð ¼ö¼ú¿¡ ÁØÇÏ¿© ´äÀ» ÁֽŠ°Í °°¾Æ¼­ »óÀÇÇÏ¿© Àû´çÈ÷ ÁÙ¿©¼­ Á¶Ã³ÇÏ¿´½À´Ï´Ù. 4ÀÏ ÀüºÎÅÍ ²÷´Â °ÍÀº ³Ê¹« ¿À·¡ÀÎ °Í °°°í ¸ÅÀÏ °Ë»çÇÒ Çʿ䵵 ¾ø´Ù°í »ý°¢µÇ¾ú±â ¶§¹®ÀÔ´Ï´Ù.


4. Warfarin°ú NOACÀÇ GI bleeding risk

1) 2017³â ¹®Çå °ËÅä.

Risk of gastrointestinal bleeding: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2017 ¹ßÇ¥: ±èÁ¤À± (2017-7-10. ¼ÒÈ­±âÁý´ãȸ)

40 articles, 43 trials, 166,289 patients randomized

ÇÙ½É µµÇ¥ÀÔ´Ï´Ù. ÀüüÀûÀ¸·Î º¼ ¶§ major GI bleedingÀº NOAC¿¡¼­ 1.5%, conventional anticoagulation¿¡¼­ 1.3%·Î º°´Ù¸¥ Â÷À̰¡ ¾ø¾ú½À´Ï´Ù.

¾àÁ¦º°·Î »ìÆìº¸¾ÒÀ» ¶§, dabigatranÀº major GI bleedingÀÌ warfarinº¸´Ù Á¶±Ý ¸¹¾Ò½À´Ï´Ù.

¾àÁ¦º°·Î »ìÆìº¸¾ÒÀ» ¶§, ribaroxabanµµ major GI bleedingÀÌ warfarinº¸´Ù Á¶±Ý ¸¹¾Ò½À´Ï´Ù.

¾àÁ¦º°·Î »ìÆìº¸¾ÒÀ» ¶§, apixabanÀº warfarin°ú ºñ½ÁÇß½À´Ï´Ù.

¾àÁ¦º°·Î »ìÆìº¸¾ÒÀ» ¶§, edoxabanµµ warfarin°ú ºñ½ÁÇß½À´Ï´Ù.

[2017-7-10.±èÅÂÁØ ±³¼ö´Ô comment]

ºñ·Ï ¸ÞŸºÐ¼®¿¡¼­ NOACÀÌ warfarin°ú ºñ½ÁÇϰųª ¾ÆÁÖ ¾à°£ ÃâÇ÷ÀÌ ¸¹Àº °ÍÀ¸·Î µÇ¾îÀÖÁö¸¸, ÀÓ»ó¿¡¼­´Â ¹Ý´ëÀÔ´Ï´Ù. ½ÇÁ¦ ÀÓ»ó¿¡¼­´Â warfarinÀÇ °æ¿ì Á¤È®Çϳª ¿ë·®À» »ç¿ëÇÏÁö ¸øÇÏ´Â °æ¿ì°¡ À־ NOACº¸´Ù ÃâÇ÷ ÇÕº´ÁõÀÌ ¸¹½À´Ï´Ù. ÀúÈñ º´¿øÀÇ real clinical data¿¡¼­µµ ¸¶Âù°¡Áö¿´½À´Ï´Ù. ¿ÍÆÄ¸°Àº Á¤È®ÇÑ º¹¾àÀÌ ¸Å¿ì ¾î·Á¿î ¾àÀÔ´Ï´Ù.


2) 2021-11-4. SMC ³»½Ã°æ ¼¼¹Ì³ª ±èÅÂÁØ ±³¼ö´Ô °­ÀÇ

°ú°Å¿¡´Â NOACÀÌ warfarinº¸´Ù À§Àå°ü ÃâÇ÷ À§ÇèÀÌ ³ô´Ù°í »ý°¢µÇ¾ú°í ±× ±âÀüÀ¸·Î low bioavailability¿Í °ü·ÃµÈ direct actionÀÌ ¾ð±ÞµÇ¾ú½À´Ï´Ù.

ÃÖ±Ù¿¡´Â warfarin¿¡¼­ À§Àå°ü ÃâÇ÷ À§ÇèÀÌ ´õ ³ô´Ù´Â ÂÊÀ¸·Î Á¤¸®µÇ°í ÀÖ½À´Ï´Ù. ´Ù¸¸ NOAC »çÀÌ¿¡¼­µµ ÀǹÌÀÖ´Â Â÷À̰¡ ÀÖ½À´Ï´Ù. ¿¬±¸¿¡ µû¶ó ´Ù¼Ò ´Ù¸£Áö¸¸ rivaroxaban, dabigatrin, edoxaban, apixaban ¼ø¼­·Î »ý°¢ÇÏ¸é µÇ°Ú½À´Ï´Ù.


5. Guidelines and reviews

1) BSG/ESGE guidelin on antiplatelets and anticoagulants (2016)

Ç×Ç÷¼ÒÆÇÁ¦, Ç×ÀÀ°íÁ¦¿¡ ´ëÇÑ À¯·´ÂÊ °¡À̵å¶óÀÎÀÌ ¹ßÇ¥µÇ¾ú½À´Ï´Ù (Veitch AM. Endoscopy 2016). ¿ª½Ã ³»½Ã°æ Á¶Á÷°Ë»ç ÇÒ ¶§¿¡´Â ¾Æ½ºÇǸ°, Ŭ·ÎÇǵµ±×·¤, ¿ÍÆÄ¸°À» ²÷Áö ¸»µµ·Ï ±ÇÇϰí ÀÖ½À´Ï´Ù. '¾Æ½ºÇǸ° + Ŭ·ÎÇǵµ±×·¤' »ç¿ëȯÀÚ¿¡¼­´Â ºñ·Ï ½Ã¼úÀÌ °íÀ§ÇèÀÌ¶óµµ Àû¾îµµ ¾Æ½ºÇǸ°Àº °è¼Ó ¾²¶ó°í ÁÖÀåÇϰí ÀÖ½À´Ï´Ù. Ŭ·ÎÇǵµ±×·¤À» ²÷´õ¶óµµ ½Ã¼ú 5ÀÏ Àü¿¡ ²÷´Â °ÍÀÔ´Ï´Ù. 7ÀÏ ÀüÀÌ ¾Æ´Ï¶ó...

°³ÀÎÀûÀ¸·Î´Â ¿ÍÆÄ¸°¸¸ »©°í ¸ðµÎ µ¿ÀÇÇÕ´Ï´Ù.

1) P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor): For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation);

For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation).

For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation).

2) Warfarin: For low-risk endoscopic procedures we suggest that warfarin therapy should be continued (low quality evidence, moderate recommendation). It should be ensured that the INR does not exceed the therapeutic range in the week prior to the procedure

3) Direct Oral Anticoagulants (DOAC): For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation). For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ¡Ã 48 hours before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30-50 mL/min we recommend that the last dose of DOAC be taken 72 hours before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation).

4) Post endoscopic procedure: If antiplatelet or anticoagulant therapy is discontinued, then we recommend this should be resumed up to 48 hours after the procedure depending on the perceived bleeding and thrombotic risks (moderate quality evidence, strong recommendation).


2) ¾Æ½Ã¾Æ ÅÂÆò¾ç °¡À̵å¶óÀÎ(Gut 2018)

When to stop and resume DOACS?

No studies are available to guide the optimal time for discontinuation or resumption of DOACs for endoscopic procedures. Currently available guidelines are conflicting. The ASGE Guidelines recommend continuation of DOACs for low-risk procedures and discontinuing anticoagulation according to the pharmacokinetic properties of individual DOACs for high-risk procedures. The BSG-ESGE Guidelines suggest omitting the morning dose of DOACs on the day of low-risk procedures and recommend the last dose of DOACs be taken at least 48?hours before high-risk procedures. Given the minimal bleeding risk associated with diagnostic endoscopy and mucosal biopsy, our Task Force does not suggest omitting DOACs before low-risk procedures. For high-risk procedures, our recommendation depends on the choice of DOAC (dabigatran vs other DOACs) and the patient¡¯s creatinine clearance. For patients on dabigatran, the last dose should be taken 48?hours before the procedure if the renal function is normal (CrCl >80?mL/min). Lengthening the period of discontinuation is required in patients with renal impairment because 80% of dabigatran metabolite is excreted by the kidneys. For patients on other DOACs (apixaban, rivaroxaban and edoxaban), we recommend the last dose should be taken 48?hours before the procedure provided that CrCl is >15?mL/min.101 Since DOACs have short half-lives and rapid onset of action, heparin bridging is not recommended. We recommend early resumption of DOACs after haemostasis has been achieved.


[FAQ]

[2016-6-23. ¾Öµ¶ÀÚ Áú¹®]

Dabigatran (ÇÁ¶ó´Ú»ç) »ç¿ë ȯÀÚ¿¡¼­ ³»½Ã°æ, Á¶Á÷°Ë»ç, Ä¡·á³»½Ã°æ ½Ã ¾à¹° Áß´Ü Áöħ¿¡ ´ëÇÏ¿© ¹®Àǵ帳´Ï´Ù.

[2016-6-25. ÀÌÁØÇà ´äº¯]

ÇÁ¶ó´Ú»ç(Dabigatran etexilate)´Â °¡Àå ¸¹ÀÌ »ç¿ëµÇ°í ÀÖ´Â »õ·Î¿î Ç×ÀÀ°íÁ¦ Áß ÇϳªÀÔ´Ï´Ù. Dabigatran¿¡ ´ëÇÑ ¿¬±¸´Â RE-LY trialÀÌ À¯¸íÇÕ´Ï´Ù. ¿¡Á¦ÄÚ¿öÃ÷ ¹Ú»çÀÇ ÀÎÅͺ信 ÀÇÇϸé RE-LY ¿¬±¸´Â Àß Á¶ÀýµÈ ¿ÍÆÄ¸°±º º¸´Ù Dabigatran 150mgÀÌ È¿´É°ú ¾ÈÀü¼ºÀÇ ¿ì¿ù¼ºÀ» ÀÔÁõÇÏ´Â ÃÖÃÊÀÇ Àӻ󿬱¸·Î ÇаèÀÇ Å« ÁÖ¸ñÀ» ¹Þ¾Ò½À´Ï´Ù. Dabigatran´Â ¿ÍÆÄ¸°±ºº¸´Ù (1) ³úÁ¹Áß ¹× Àü½Å»öÀüÁõ ¹ß»ý À§Çè (2) Ç÷°üÁúȯ °ü·Ã »ç¸Á·ü (3) ÁÖ¿ä ÃâÇ÷ °Ç(major bleeding events) (4) µÎ°³ ³» ÃâÇ÷ µîÀ» À¯ÀÇÇÏ°Ô °¨¼Ò½ÃÄ×½À´Ï´Ù. ƯÈ÷ ÁÖ¸ñÇÒ Á¡Àº ÇÁ¶ó´Ú»ç°¡ »õ·Î¿î °æ±¸¿ë Ç×ÀÀ°íÁ¦ Áß ¿ÍÆÄ¸° ´ëºñ ÇãÇ÷¼º ³úÁ¹Áß À§ÇèÀ» ÁÙÀÌ´Â È¿°ú¸¦ ÀÔÁõÇß½À´Ï´Ù.

³»½Ã°æÀÇ»ç·Î¼­ °ü½ÉÀÌ ÀÖ´Â ºÎºÐÀº Ä¡·á³»½Ã°æ Àü DabigatranÀ» ²÷´Â ½ÃÁ¡ÀÔ´Ï´Ù. Thrombosis and HaemostasisÀÇ ¸®ºä¿¡ ÀÇÇÏ¸é ½ÅÀå±â´É¿¡ µû¶ó ¾àÀ» ²÷´Â ½ÃÁ¡ÀÌ ´Þ¶óÁú Çʿ䰡 ÀÖ´Ù°í ÇÕ´Ï´Ù. ¾Æ·¡ tableÀ» ÂüÁ¶ÇÏ¸é µÇ°Ú½À´Ï´Ù. º¸Åë ¿ÍÆÄ¸°º¸´Ù ÈξÀ ª°Ô ²÷¾îµµ ÁÁ±â ¶§¹®¿¡ »ç¿ëÇÏ±â Æí¸®ÇÒ °Í °°½À´Ï´Ù.

[2019-8-6. ¾î¶² ½ÉÀå³»°ú ¼±»ý´ÔÀÇ ¼º½ÇÇÑ ´äº¯]

¿¡µ¶»ç¹Ý º¹¿ë ȯÀÚ


[2020-4-17. Áú¹®]

°í·É ³²¼ºÀ¸·Î ¿©·¯ ½ÉÇ÷°ü ÁúȯÀ¸·Î rivaroxaban°ú clopidogrelÀ» ¸ðµÎ º¹¿ë ÁßÀÎ ºÐÀÔ´Ï´Ù. 2-3ÁÖ ÀüºÎÅÍ º¯ÀÌ °³¿îÄ¡ ¾Ê°í, °¡½º°¡ ÀÚÁÖ Â÷´Â Áõ»óÀ¸·Î ³»½Ã°æ ½ÃÇà µî Áø·á ÀǷڵǾú´ø ºÐÀ¸·Î ¿ì¼±Àº EGD, colonoscopy ½ÃÇàÀ» Çϱâ·Î °áÁ¤Çß½À´Ï´Ù. ¿Ü·¡ º¼ ´ç½Ã¿¡´Â ÇϺΠEMR ½ÃÇà ¿©ºÎ¸¦ °í·ÁÇÏÁö ¸øÇϰí biopsy °¡´É¼º¸¸ °í·ÁÇØ¼­ ¿ì¼±Àº clopidogrelÀº À¯ÁöÇϰí rivaroxaban¸¸ Áß´ÜÇÏ°í ¿À¶ó°í Çß¾ú½À´Ï´Ù. ´ëÀå³»½Ã°æ ¼Ò°ß¿¡¼­ T-colon¿¡¼­ 1.2cm °¡·®ÀÇ LST°¡ ³ª¿Í¼­, clopidogrel º¹¿ë·Â ¶§¹®¿¡ EMRÀº ½ÃÇàÇÏÁö ¸øÇϰí Á¶Á÷°Ë»ç ½ÃÇàÇß°í tubular adenoma°¡ È®ÀεǾú½À´Ï´Ù.

»ç½Ç ÀÌ È¯ÀÚ¿¡¼­ malignancy °¨º°ÇÏ´Â°Ô Áß¿äÇÏ´Ù »ý°¢Çؼ­ Ç×Ç÷¼ÒÆÇÁ¦ Áß´ÜÀº Å©°Ô °í·ÁÇÏÁö ¾Ê¾Ò¾ú´Âµ¥, ¸·»ó ´ëÀå³»½Ã°æ¿¡¼­ LST ¼Ò°ßÀÌ °üÂûµÇ°í º¸´Ï ÇùÁø ÈÄ ¾àÀ» Á» ´õ ²÷Áö ¾Ê¾Ò´ø °ÍÀÌ ¾Æ½¬¿ü½À´Ï´Ù. ±×·±µ¥ ½Ã¼ú °¡´É¼ºÀ» °í·ÁÇØ¼­ ¹«Á¶°Ç ¾àÀ» ¸¹ÀÌ Áß´ÜÇϰí colonoscopy¸¦ ÁøÇàÇÏ´Â °ÍÀÌ ¸Â´Â°¡¿¡ ´ëÇÑ Àǹ®µµ µé¾ú½À´Ï´Ù. Colonoscopy´Â bowel prepÀ» ÇÏ´Â °ÍÀÌ ¾î·Æ±â ¶§¹®¿¡, CPP/EMR °¡´É¼ºÀ» °í·ÁÇØ¼­ antiplatelet, anticoagulationÀ» Áß´ÜÇϰí ÁøÇàÇÏ´Â °ÍÀÌ ¸ÂÀ»Áö¿ä?

[2020-4-18. ÀÌÁØÇà ´äº¯]

¾ÆÁÖ Á¤È®È÷ Àß ÇϽаÍÀÔ´Ï´Ù. ¾Æ½¬¿öÇÒ ÀÌÀ¯°¡ ÀüÇô ¾ø½À´Ï´Ù. ¿ÀÈ÷·Á ¾Æ½¬¿öÇÏ¸é ¾È µË´Ï´Ù. ½Ã¼ú °¡´É¼ºÀ» °í·ÁÇÏ¿© ¹Ì¸® ¾àÀ» ÃæºÐÈ÷ ²÷°í ÁøÇàÇÏ´Â °ÍÀº Ʋ¸° °ÍÀÔ´Ï´Ù. Bowel preprationÀÌ ¾î·Æ´Ù´Â ÀÌÀ¯·Î ºÒÇÊ¿äÇÏ°Ô ¾àÀ» ²÷À¸¸é ȯÀÚ°¡ Á×À» ¼ö ÀÖ½À´Ï´Ù.

ÀÏÀü¿¡µµ ¸»¾¸µå·ÈÁö¸¸ °¡À̵å¶óÀÎÀ» ÁöŰ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. AspirinÀ̳ª clopidogrelÀ» º¹¿ë ÁßÀΠȯÀÚÀÇ ³»½Ã°æ °Ë»ç, Á¶Á÷°Ë»ç¿¡¼­´Â ¾à¹° Áß´ÜÀÌ ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. NOACµµ ´çÀÏ ¾ÆÄ§ ¾È µå½Ã¸é µË´Ï´Ù. ÀÌ °æ¿ì high risk procedure·Î »ý°¢µÇ´Â CPP³ª EMRÀº ÇÏÁö ¸øÇÒ °ÍÀÔ´Ï´Ù. ±×·¯³ª ¸ðµç ³»½Ã°æ °Ë»ç¿¡¼­ high risk polypectomy¸¦ one stage·Î ÇØ¾ß ÇÑ´Ù°í »ý°¢µÇÁö ¾Ê½À´Ï´Ù. Ȥ½Ã ¸ð¸¦ high risk polypectomy¸¦ À§ÇÏ¿© ¸ðµç ȯÀÚ¿¡¼­ aspirinÀ̳ª clopidogrelÀ» ³»½Ã°æ °Ë»ç Àü¿¡ Áß´ÜÇÑ´Ù¸é µæº¸´Ù ½ÇÀÌ ¸¹À» °¡´É¼ºÀÌ Å®´Ï´Ù. °¡À̵å¶óÀο¡¼­µµ À̸¦ ±ÇÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù.

Áø´ÜÀº Áø´ÜÀ̰í Ä¡·á´Â Ä¡·á¶ó´Â Á¡À» ¸íÈ®È÷ ±¸ºÐÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. ƯÈ÷ aspirin/clopidogrel/warfarin/NOACÀ» º¹¿ëÇÏ´Â ºÐ¿¡¼­´Â ´õ¿í ±×·¯ÇÕ´Ï´Ù. °íÀ§Çè ȯÀÚ¿¡¼­ ¹«¸®ÇÏ¿© ½Ã¼úÇÏ´Ù°¡ »ç°í°¡ ³ª´Â ¹ýÀÔ´Ï´Ù. ¾à°£ÀÇ Æí¸®º¸´Ù ¾ÈÀüÀÌ ÈξÀ Áß¿äÇÑ °¡Ä¡ÀÔ´Ï´Ù.

ÀÏ´Ü Áø´ÜÀû °Ë»ç¸¦ Çϰí, Ȥ½Ã ½Ã¼úÀÌ ÇÊ¿äÇÑ º´¼Ò°¡ ¹ß°ßµÇ¸é ´Ù½Ã »ó´ãÇÏ°í ¾àÀ» ÀûÀýÈ÷ Á¶ÀýÇÑ ÈÄ Ä¡·áÀû ³»½Ã°æÀ» ÇÏ¸é µË´Ï´Ù. ¾àÀ» µå½Ã°í °è½Å °íÀ§Çè ȯÀÚ¿¡¼­ ´ëÀå³»½Ã°æÀ» Çѹø¿¡ ¸¶Ä¡·Á°í ½ÃµµÇÏ´Â °ÍÀº À§ÇèÇÏ°í ¹«¸®ÀÔ´Ï´Ù. ÇÊ¿äÇÏ¸é µÎ ¹ø ÇÒ ¼ö ÀÖ´Â °ÍÀÌ ´ëÀå³»½Ã°æÀÔ´Ï´Ù. Àý´ë ¿å½É³»Áö ¸¶½Ê½Ã¿À.

[2021-5-4] Apixaban Áú¹®

[2021-9-29] 'EndoTODAY ´ë¿øÁ¦¾à ¼ö¿ä ³»½Ã°æ ¼¼¹Ì³ª'¿¡¼­ ±èµµÈÆ ±³¼ö´ÔÀÇ °­ÀǸ¦ µé¾ú½À´Ï´Ù. ±× Áß NOAC (= DOAC)ÀÇ Ç×ÀÀ°íÈ¿°ú ±âÀü¿¡ ´ëÇÑ ³»¿ëÀ» ¼Ò°³ÇÕ´Ï´Ù. Systemic effect »Ó¸¸ ¾Æ´Ï°í 'Á÷Á¢ÀûÀÎ ±¹¼Ò Ç×ÀÀ°íÈ¿°ú'°¡ ÀÖ´Ù°í ÇÕ´Ï´Ù.


[2022-7-16] À̽ºÆ® ¾Æ½Ã¾È ÆÄ¶óµ¶½º East Asian Paradox


[2022-9-23] ½ÉÀåÇÐȸ¿¡¼­ "optimal anti-platelet and anti-cagulation treatment before diagnostic and therapeutic endoscopy (an endoscopist's perspective)"¶ó´Â Á¦¸ñÀÇ °­ÀÇ¿Í Åä·ÐÀ» ÇÏ¿´½À´Ï´Ù. Á¦ °­ÀÇ ¿äÁöÀÔ´Ï´Ù.

1. ¿ì¸®³ª¶ó¿¡¼­ ³»½Ã°æ Àü Ç×Ç÷¼ÒÆÇÁ¦³ª Ç×ÀÀ°íÁ¦¸¦ ÇÊ¿ä ÀÌ»óÀ¸·Î ¿À·¡ ²÷´Â ȯÀÚ°¡ ¸¹½À´Ï´Ù. ±×·Î ÀÎÇÑ ÁßdzÀ̳ª AMI¸¦ ÀÚÁÖ °æÇèÇϰí ÀÖ½À´Ï´Ù. ÀÌÀ¯´Â ¿©·µÀÔ´Ï´Ù. (1) ½º½º·Î ¾àÀ» ¿À·¡ ²÷¾î¾ß ÇÑ´Ù°í »ý°¢Çϴ ȯÀÚ°¡ ¸¹½À´Ï´Ù. °ú°ÅÀÇ Áø·á °æÇè¿¡ ÀÇÇÑ °ÍÀ̱⵵ ÇϰÚÁö¸¸ Á¦°¡ Á¤È®È÷ ÀÌÇØÇÏÁö ¸øÇÏ´Â ÀÌÀ¯·Î ÃâÇ÷À» ¹«¼­¿öÇÏ´Â ºÐµéÀÌ ¸¹½À´Ï´Ù. ÃâÇ÷Àº ´«¿¡ º¸ÀÌ´Â À§ÇèÀÌÁö¸¸, »ç½Ç ½ÉÇ÷°ü°è ÇÕº´ÁõÀÌ ´õ¿í ¹«¼­¿î °á°ú¸¦ °¡Áö°í ¿É´Ï´Ù. ȯÀÚµéÀÌ µÎ °¡Áö À§ÇèÀÇ ±ÕÇüÀ» »ý°¢ÇÏÁö´Â ¸øÇÒ °Í °°½À´Ï´Ù. 3ºÐ Áø·á¸¦ Çϸ鼭 À̸¦ ¼³¸íÇÒ ¼öµµ ¾ø½À´Ï´Ù. (2) ¾àÀ» ¿À·¡ ²÷Áö ¾ÊÀ¸¸é °Ë»çÇØÁÖÁö ¸øÇϰڴٴ º´¿øÀ̳ª °ËÁø¼¾ÅͰ¡ ÀÖ½À´Ï´Ù. ÃâÇ÷ ÇÕº´Áõ ¹ß»ý ½Ã °ï¶õÇÑ »óȲ¿¡ ºüÁø °æÇèÀÌ ÀÖ´Â º´¿ø¿¡¼­ ±×¿Í °°Àº ¹æÄ§À» °¡Áö°í ÀÖ´Â °Í °°½À´Ï´Ù. ³»½Ã°æ ÈÄ ÃâÇ÷ÀÌ ¹ß»ýÇÏ¿© ¹Î¿øÀ̳ª ¼Ò¼Û µîÀ¸·Î ¿¬°áµÇ¾î Å« °íÅëÀ» ¹Þ´Â ÀÇ»çµéµµ ÀûÁö ¾Ê½À´Ï´Ù. ¾î¿ ¼ö ¾øÀÌ µ¿¹ÝµÇ´Â ÇÕº´ÁõÀ¸·ÎºÎÅÍ ÀÇ·áÁøÀ» º¸È£ÇÏ´Â ½Ã½ºÅÛÀÌ ÇÊ¿äÇÕ´Ï´Ù. (3) ½ÉÇ÷°üÁúȯ Àü¹®°¡µéµµ °£È¤ °¡À̵å¶óÀκ¸´Ù ±æ°Ô ¾àÀ» ²÷±â¸¦ ±ÇÇϱ⵵ ÇÕ´Ï´Ù. (4) ¿µ¾î Ç¥ÇöÀ» ¿ì¸®¸»·Î ¿Å±â´Â °úÁ¤¿¡¼­ ÇÏ·ç ´õ ²÷´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù.

2. ¾Ö½Ã´çÃÊ ºÒÇÊ¿äÇÑ ³»½Ã°æ °Ë»çµµ ¸¹½À´Ï´Ù. ÁßÁõ ½ÉÇ÷°ü°è ÁúȯÀÌ ÀÖ´Â °íÀ§Çè ȯÀÚ´Â °ËÁø ³»½Ã°æÀÇ ´ë»óÀÌ ¾Æ´Õ´Ï´Ù. ±×·³¿¡µµ ºÒ±¸ÇÏ°í ºÒÇÊ¿äÇÑ °ËÁø ³»½Ã°æÀ» À§ÇÏ¿©, ºÒÇÊ¿äÇÏ°Ô ¾àÀ» ²÷°í, ºÒÇÊ¿äÇÏ°Ô À§Çè¿¡ ³ëÃâµÇ¾î, ºÒÇÊ¿äÇÏ°Ô ÇÕº´ÁõÀ» °æÇèÇÏ´Â »ç·Ê¸¦ º¸¸é ¾ÈŸ±õ½À´Ï´Ù. ¿ì¸®³ª¶ó ÀÇ·á ÇöÀåÀÇ °úÀ× °Ë»ç´Â Å« ¹®Á¦ÀÔ´Ï´Ù. Àú¼ö°¡°¡ ±Ùº» ¿øÀÎÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.

3. °­ÀÇ Á¦¸ñ¿¡µµ before¶ó´Â ´Ü¾î°¡ µé¾îÀÖ½À´Ï´Ù. ½ÉÇ÷°üÁúȯ Àü¹®°¡µéÀº before¸¦ ÀǽÄÇÕ´Ï´Ù. ³»½Ã°æ ÀÇ»çµéÀº ½Ã¼ú Áß ¹ß»ýÇÏ´Â ÃâÇ÷Àº Àß ÇØ°áÇÒ ¼ö ÀÖ½À´Ï´Ù. ÀúÈñµé¿¡°Ô´Â after°¡ Áß¿äÇÕ´Ï´Ù. ¼ö¼úÀ» ÀýÁ¦¸¦ ÇÑ ÈÄ ºÀÇÕÀ» ÇÕ´Ï´Ù. ³»½Ã°æÀº ÀýÁ¦¸¦ ÇÑ ÈÄ º´¼Ò¸¦ ºÀÇÕÇÒ ¼ö ¾øÀ¸¹Ç·Î ³ëÃâµÈ »óŰ¡ µË´Ï´Ù. ½Ã¼ú ÈÄ Áö¿¬ ÃâÇ÷ÀÇ À§ÇèÀÌ Å®´Ï´Ù. ÀúÈñ¿¡°Ô´Â after°¡ Áß¿äÇÕ´Ï´Ù. ½Ã¼ú ÈÄ ¾ðÁ¦ ¾àÀ» ´Ù½Ã ½ÃÀÛÇÒ °ÍÀÎÁö°¡ Áß¿äÇѵ¥ ÀÌ´Â »ó¼¼È÷ ´Ù·ïÁöÁö ¸øÇϰí ÀÖ½À´Ï´Ù. ½Ã¼ú Àü ¾à¹° Áß´Ü ±â°£À» ÁÙÀÌ°í ½Ã¼ú ÈÄ ¾à¹° ½ÃÀÛ ½ÃÁ¡À» ´ÊÃß´Â °ÍÀÌ ÁÁ°Ú´Ù°í »ý°¢ÇÕ´Ï´Ù.
4. DOAC (NOAC)ÀÌ °ÆÁ¤ÀÔ´Ï´Ù. AntiplateletÀ̳ª warfarinÀº õõÈ÷ ÀÛ¿ëÇÏ´Â ¾àÁ¦ÀÎÁö¶ó ³»½Ã°æ ½Ã¼ú ÈÄ ÃâÇ÷ÀÌ ¹ß»ýÇÏ´õ¶óµµ õõÈ÷ ¹ß»ýÇÕ´Ï´Ù. ±×·±µ¥ direct acting drugÀÎ DOACÀº Áï½Ã ºü¸£°Ô ÀÛ¿ëÇÏ¿© NOAC µå½Ã°í °ð ÃâÇ÷Çϴ ȯÀÚ°¡ ÀÖ½À´Ï´Ù. NOAC´Â half dose·Î ½ÃÀÛÇÏ¸é ¾î¶»±î¿ä? ±Ù°Å´Â ¾ø½À´Ï´Ù. ÀúÀÇ °³ÀÎÀûÀÎ Èñ¸ÁÀÏ »ÓÀÔ´Ï´Ù¸¸.

5. ¾ð¾î Ç¥ÇöÀÇ ¹®Á¦µµ ÀÖ½À´Ï´Ù. À§³»½Ã°æ ¹× Á¶Á÷°Ë»ç¸¦ À§Çؼ­¶ó¸é DOACÀº ²÷À» Çʿ䰡 ¾ø´Â ¾àÀÔ´Ï´Ù. °¡À̵å¶óÀο¡´Â omit DOAC on morning of procedure¶ó°í µÇ¾î ÀÖ½À´Ï´Ù. ¼­¾ç½Ä Ç¥ÇöÀ¸·Î´Â ÇÏ·ç ²÷´Â´Ù°í ÇÒ ¼ö ÀÖÀ¸³ª ¿ì¸®¸» Ç¥ÇöÀ¸·Î´Â '²÷Áö ¾Ê´Â´Ù'°¡ Àû´çÇÕ´Ï´Ù. Àü³¯±îÁö ¾àÀ» µå½Ã°í ³»½Ã°æ °Ë»çÀÏ ¾ÆÄ§¿¡¸¸ ¾àÀ» µå½ÃÁö ¸¶¼¼¿ä..... ¿ì¸® ȯÀÚ¿¡°Ô´Â '¾àÀ» ²÷Áö ¸¶¼¼¿ä. Àü³¯±îÁö µå¼¼¿ä'¶ó°í Ç¥ÇöÇØ¾ß ÇÕ´Ï´Ù. High risk procedure¸¦ À§ÇÏ¿© DOACÀº ÀÌÆ² ²÷´Â ¾àÀÌ ¾Æ´Õ´Ï´Ù. °¡À̵å¶óÀÎÀº 48½Ã°£ Àü¿¡ ¸¶Áö¸· ¾àÀ» ¸ÔÀ¸¶ó°í µÇ¾î ÀÖ½À´Ï´Ù. ¿ì¸®¸»·Î Ç¥ÇöÇϸé ÀÌÆ² ²÷´Â °ÍÀÌ ¾Æ´Ï°í 'ÇÏ·ç ²÷À¸¼¼¿ä'ÀÔ´Ï´Ù. ¼­¾ç¿¡¼­´Â ¾ÆÀ̰¡ ž¸é 0»ìÀÔ´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­´Â ¾ÆÀ̰¡ ž¸é 1»ìÀÔ´Ï´Ù. À̹ø¿¡ Á¤Â÷ÇÒ ¿ªÀÇ ¿µ¾î Ç¥ÇöÀº next stationÀÔ´Ï´Ù. Á÷¿ªÇϸé Àǹ̰¡ ´Þ¶óÁý´Ï´Ù. ¾ð¾îÇ¥Çö»óÀÇ À̽´·Î ÀÎÇÏ¿© ¿ì¸® ȯÀÚµéÀº ¼­¾çÀÇ °¡À̵å¶óÀκ¸´Ù ÇϷ羿 ¾àÀ» ´õ ²÷°í ÀÖ½À´Ï´Ù. ¿ì¸®³ª¶ó °¡À̵å¶óÀÎÀº ¿ì¸®¸»·Î ¸¸µé¾î¾ß ÇÕ´Ï´Ù. ¼­¾ç °¡À̵å¶óÀÎÀ» ¼Ò°³ÇÒ ¶§¿¡´Â ¾ð¾î Ç¥ÇöÀÇ Â÷ÀÌ¿¡ ¼¼½ÉÇÏ ÁÖÀǰ¡ ÇÊ¿äÇÕ´Ï´Ù.


[References]

1) EndoTODAY Ç×Ç÷¼ÒÆÇÁ¦

2) EndoTODAY ³»½Ã°æ ȤÀº Á¶Á÷°Ë»ç Àü ¾Æ½ºÇǸ°, Ç×Ç÷¼ÒÆÇÁ¦¸¦ ²÷À» °ÍÀΰ¡?

3) 2015-11-12. ¼ö¼ú/½Ã¼ú ÈÄ ¿ÍÆÄ¸° »ç¿ëÀ» À߸øÇÏ¿© ÀÇ·áºÐÀï

ÀçÆÇºÎ´Â "Ç÷Àü ¹ß»ý À§ÇèÀÌ Àִ ȯÀÚ°¡ ¿ÍÆÄ¸° º¹¿ëÀ» Áß´ÜÇÏ°í ´Ù½Ã º¹¿ëÇÒ ¶§ INRÀÌ Á¤»ó ¼öÄ¡¿¡ µµ´ÞÇϱâ À§Çؼ­´Â 4~6ÀÏ Á¤µµ °É¸°´Ù"¸ç "¹Ú ¾¾´Â ¼ö¼ú Á÷Àü INRÀÌ 1.5·Î¼­ Á¤»óº¸´Ù ³·Àº »óÅ¿´±â ¶§¹®¿¡ ¼ö¼ú ÈÄ Ç÷Àü ¿¹¹æÁ¶Ä¡¸¦ ÃëÇØ¾ß ÇÒ Çʿ䰡 ÀÖ¾ú´Ù"°í ¹àÇû´Ù.

À̾î "ÃâÇ÷ À§Ç輺ÀÌ Å©Áö ¾ÊÀº ¼ö¼úÀ̸é Ç×ÀÀ°íÁ¦ º¹¿ë ȯÀÚ¿¡°Ô ¼ö¼ú ÈÄ Ç×ÀÀ°íÁ¦¸¦ ÀçÅõ¿©ÇÏ´Â °ÍÀÌ ¿øÄ¢"À̶ó¸ç "ÃâÇ÷ À§ÇèÀÌ ÀÖ´Â ¼ö¼úÀº Ç×ÀÀ°íÁ¦¸¦ Áï°¢ ÀçÅõ¿©Çϱ⠾î·Á¿î ¹Ý¸é Ç÷Àü À§Çèµµ ÀÖÀ¸¹Ç·Î ½Å°æ°ú³ª ½ÉÀå³»°ú¿Í ÇùÁøÀ» ÅëÇØ ¾ÈÁ¤¼º À¯¹«¿¡ ´ëÇÑ Àü¹®Àû ÀǰßÀ» ±¸ÇØ¾ß ÇÑ´Ù"°í ÆÇ½ÃÇß´Ù.

4) [¸®ºä] À强¿ø. New Oral Anticoagulants¶õ? ´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸÁö 2017

5) ±è°æ¿À. ³»½Ã°æ ½Ã¼ú ½Ã °í·Á»çÇ×(±æÀâÀÌ): Novel Oral Anticoagulants ´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸÁö 2017 º¹¿ë ÁßÀΠȯÀÚ¿¡¼­

6) ÆÄÇìÃĺ¸ÀÚ! »õ·Î¿î Ç×ÀÀ°íÁ¦¡¦ ºÐ´ç¼­¿ï´ëÇб³º´¿ø Ç÷¾×Á¾¾ç³»°ú ¹æ¼ö¹Ì PPT PDF 1.5M

7) NOACÀÇ ¾à¸®Çаú ¾à¸®ÇÐÀû Ư¼º ±è¹Î¼ö. 2021 ´ëÇÑ ºÎÁ¤¸ÆÇÐȸ. ´ÚÅͺô

8) Ç×Ç÷ÀüÁ¦¿Í PPIÀÇ »ç¿ë ¼­Àçºó. ´ÚÅͺô



© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.