pISSN 1226-6051
eISSN 2508-786X
eISSN 2508-786X
Comparison of Korean Clinical Practice Guideline for Stoke (KCPGS) for anticoagulants treatment before and after revision and comparison with AHA/ASA guidelines
| Previous KCPGS of 2009 | Current KCPGS of 2022a | Change | AHA/ASA Guidelines of 2019 |
|---|---|---|---|
| 1. There is no scientific evidence on the usefulness of heparin used within 48 hours of ischemic cerebral infarction. It might increase the risk of bleeding, compared with aspirin (LOE: Ia, GOR: A) | 1. There is no scientific evidence on the usefulness of heparin used within 48 hours of ischemic cerebral infarction. It might increase the risk of bleeding, compared with aspirin (LOE: Ia, GOR: A) | No change | 1. The usefulness of urgent anticoagulation in patients with severe stenosis of an internal carotid artery ipsilateral to an ischemic stroke is not well established. (COR: IIb, LOE: B-NR) b 2. The safety and usefulness of short-term anticoagulation for nonocclusive, extracranial intraluminal thrombus in the setting of AIS are not well established. (COR: IIb, LOE: C-LD) b 3. At present, the usefulness of argatroban, dabigatran, or other thrombin inhibitors for the treatment of patients with AIS is not well established. (COR: IIb, LOE: B-R) b 4. The safety and usefulness of oral factor Xa inhibitors in the treatment of AIS are not well established. (COR: IIb, LOE: C-LD) b 5. Urgent anticoagulation, with the goal of preventing early recurrent stroke, halting neurological worsening, or improving outcomes after AIS, is not recommended for treatment of patients with AIS. (COR III: No Benefit, LOE A) b |
| 2. LMWH or heparinoids is not recommended as an early treatment of cerebral infarction (LOE: Ia, GOR: A) | 2. LMWH or heparinoids is not recommended as an early treatment of cerebral infarction (LOE: Ia, GOR: A) | No change | |
| 3. Use of anticoagulants within 24 hours of intravenous tPA administration is not recommended (LOE: IIa, GOR: B) | 3. Use of anticoagulants within 24 hours of intravenous tPA administration is not recommended (LOE: IIa, GOR: B) | No change | |
| 4. For patients with acute ischemic stroke and atrial fibrillation, it is recommended to start oral anticoagulation when the risk of hemorrhagic transformation is expected to be low. It may be reasonable to start oral anticoagulation between 4 and 14 days after stroke onset. However, in patients with high risk of recurrent stroke and low risk of hemorrhagic transformation, oral anticoagulation might be initiated within 5 days from stroke onset (LOE: III, GOR: B) | New recommendation. | 1. For most patients with an AIS in the setting of atrial fibrillation, it is reasonable to initiate oral anticoagulation between 4 and 14 days after the onset of neurological symptoms. (COR: IIa, LOE: B-NR) c | |
AHA, American Heart Association; AIS, acute ischemic stroke; ASA, American Stroke association; COR, class of recommendation; GOR, grade of recommendation; KCPGS, Korean
Clinical Practice Guideline for Stoke; LMWH, low molecule weight heparin; LOE, level of evidence; TIA, transient ischemic attack; tPA, tissue plasminogen activator
a [2.3.5.Anticoagulants]
b [e378, 3. General Supportive Care and Emergency Treatment 3.10. Anticoagulant treatment]
c [e394, 6. In-Hospital Institution of Secondary Stroke Prevention 6.6.2. Atrial Fibrillation]
Recent changes in KCPGS and corresponding parts in AHA/ASA guidelines are underlined