Jong Sung Park

Lee KY, et al. Korean Circ J. 2026 ;56:e82. https://doi.org/10.4070/kcj.2025.0429

Jong-Sung Park, Ph.D., Kyung Hee Lim, M.D., Dae-Hyun Kim, M.D., Kwang-Min Lee, Ph.D., Kwang-Sook Woo, M.D., and Jin-Yeong Han, Ph.D.. Ann Lab Med -0001;0:. https://doi.org/10.3343/alm.2025.0144

Aims: This study, using a prospective cohort, evaluated the effectiveness and safety of off-label reduced-dose apixaban vs. the on-label dose in atrial fibrillation (AF) patients meeting a single-dose reduction criterion. Methods and results: The efficAcy and Safety of aPixaban In REal-world practice in Korean frail patients with AF (ASPIRE) study is a multicentre, prospective observational cohort involving AF patients who met a single-dose reduction criterion of apixaban. Patients were divided into two groups: an on-label standard dose (5 mg twice daily) and an off-label reduced dose (2.5 mg twice daily). The primary effectiveness outcome was stroke/systemic embolism (SSE), and the primary safety outcome was major bleeding. Of 1944 patients (mean age 74.3 ± 7.9 years, 56% women), 997 (51%) were receiving off-label reduced-dose apixaban. The off-label reduced-dose group was older, had more comorbidities, higher concomitant antiplatelet use, and higher CHA2DS2–VASc and HAS-BLED scores. During follow-up (1.0 ± 0.2 year), crude incidence rates were 0.9 vs. 0.7 per 100 person-years for SSE and 0.5 vs. 1.0 for major bleeding in the on-label vs. off-label groups. After inverse probability of treatment weighting, the off-label reduced-dose group showed no significant differences in the risk of SSE [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.28–1.59, P = 0.370] and major bleeding (HR 1.38, 95% CI 0.44–4.35, P = 0.578) compared with the on-label standard dose group. Conclusion: In Korean patients with AF meeting a single-dose reduction criterion of apixaban, off-label reduced-dose apixaban showed no significant differences in SSE and major bleeding compared with the on-label standard dose. These findings suggest that individualized anticoagulation strategies, such as reduced-dose apixaban, may be beneficial for patients with a high risk of bleeding.

Background: The detection of atrial fibrillation (AF) after a cryptogenic stroke (CS) carries important therapeutic implications. In this study, we aimed to accurately assess the incidence of AF among CS subjects by using an insertable cardiac monitor (ICM). Methods: A prospective, single-arm, multicentre registry was conducted to identify AF in 155 CS subjects using the Confirm Rx ICM (Abbott, California, USA) across 20 global sites. Inclusion criteria comprised participants aged 40 years or older who had experienced CS within a 90-day window. At each follow-up visit, expert electrophysiologists reviewed and adjudicated ICM detected AF episodes. The primary endpoint was the cumulative incidence of true device-detected AF (lasting more than 30 s) at 6 months, evaluated with Kaplan-Meier methods. Results: AF incidence was 21.3% (95% CI 15.3% to 29.1%) at 6 months, increasing to 48.8% (95% CI 34.7% to 64.9%) at 24 months. Subjects with AF detection experienced an average of 50.9 true AF episodes per subject per year. The median time from implantation to AF detection (>30 s) was 72 days (IQR 7–261). Among subjects with 30 s AF detection, anticoagulation therapy was initiated in 65.2% (30/46) of subjects. Oral anticoagulation medication was prescribed in 8.3% (9/109) of subjects without AF. Recurrent ischaemic stroke or transient ischaemic attack occurred in 5 subjects (3.2%, 5/155). Conclusion: These results show that ICM-driven long-term continuous AF monitoring is associated with high diagnostic yield in CS subjects. Trial registration number: NCT03505801

Lim KH, et al. Korean Circ J. 2025 May;55:e95. https://doi.org/10.4070/kcj.2025.0124

Dae-Hyun Kim, M.D., Byung-Cheol Kwak, M.D., Byeol-A Yoon, M.D., Jae-Kwan Cha, M.D., Jong-Sung Park, M.D., Min-Sun Kwak, M.D., Kwang-Sook Woo, M.D., and Jin-Yeong Han, M.D., Ph.D.. Ann Lab Med -0001;0:. https://doi.org/10.3343/alm.2024.0036

Atrial fibrillation (AF) increases the risk of thromboembolic events, making oral anticoagulants (OACs) essential for high-risk patients. This fact sheet provides nationwide statistics on AF management for stroke prevention in Korea. We aimed to evaluate current anticoagulation treatment trends and strategies in Korea. The Korean national health claims database from the National Health Insurance Service was used. AF patients aged ≥ 18 years from 2013 to 2022 were included. OAC use, including warfarin and non-vitamin K antagonist OACs (NOACs), was tracked through prescription data. The rates of OAC use were calculated based on continued use, considering prescription dates and amounts. For patients with multiple encounters, the last encounter was used for analysis. During the study, 20.4% of strokes were accompanied by AF, with AF diagnosed within 6 months before or after the stroke. The number of patients diagnosed with AF after a stroke increased from 4893 in 2013 to 6978 in 2022. Among newly diagnosed AF patients requiring OACs, 51% were not prescribed OACs within 6 months. OAC treatment rates for high-risk AF patients increased from 44.6% in 2013 to 77.5% in 2022, with NOAC prescriptions rising significantly after 2015. Regional variations in OAC prescription rates were observed, with lower rates in suburban/rural areas than in urban regions (76.0% vs. 79.6%, p < 0.001). Considerable strokes could have been prevented with earlier AF detection and OAC treatment through more intensive electrocardiogram screening.

Kim JY, et al. Korean Circ J. 2024 May;54:e54. https://doi.org/10.4070/kcj.2024.0084

대한심장호흡재활의학회지(Annals of CardioPulmonary Rehabilitation)