메뉴 건너뛰기




Volumn 27, Issue 1, 2010, Pages 39-50

Reasons for undertreatment with oral anticoagulants in frail geriatric outpatients with atrial fibrillation: A prospective, descriptive study

Author keywords

Anticoagulants, therapeutic use; Drug utilisation; Elderly; Prescribing

Indexed keywords

ACETYLSALICYLIC ACID; ANTICOAGULANT AGENT; COUMARIN;

EID: 73849098278     PISSN: 1170229X     EISSN: 11791969     Source Type: Journal    
DOI: 10.2165/11319540-000000000-00000     Document Type: Article
Times cited : (98)

References (45)
  • 1
    • 0036452343 scopus 로고    scopus 로고
    • Atrial fibrillation in the elderly: Facts andmanagement
    • Chatap G, Giraud K, Vincent J. Atrial fibrillation in the elderly: facts andmanagement.DrugsAging 2002; 19: 819-846
    • (2002) Drugs Aging , vol.19 , pp. 819-846
    • Chatap, G.1    Giraud, K.2    Vincent, J.3
  • 2
    • 0035940379 scopus 로고    scopus 로고
    • ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: Executive summary
    • A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for practice guidelines and policy conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology
    • Fuster V, Rydén LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for practice guidelines and policy conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Circulation 2001; 104: 2118-2150
    • (2001) Circulation , vol.104 , pp. 2118-2150
    • Fuster, V.1    Rydén, L.E.2    Asinger, R.W.3
  • 3
    • 33747437950 scopus 로고    scopus 로고
    • Guidelines for the management of patients with atrial fibrillation: Executive summary
    • ACC/AHA/ESC 2006
    • Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: executive summary. Circulation 2006; 114: 700-752
    • (2006) Circulation , vol.114 , pp. 700-752
    • Fuster, V.1    Ryden, L.E.2    Cannom, D.S.3
  • 4
    • 0031728632 scopus 로고    scopus 로고
    • Antithrombotic therapy in atrial fibrillation
    • Laupacis A, Albers G, Dalen J, et al. Antithrombotic therapy in atrial fibrillation. Chest 1998; 114: 579-589
    • (1998) Chest , vol.114 , pp. 579-589
    • Laupacis, A.1    Albers, G.2    Dalen, J.3
  • 5
  • 6
    • 0034153308 scopus 로고    scopus 로고
    • Frequency of anticoagulation for atrial fibrillation and reasons for its nonuse at a Veterans Affairs medical center
    • Bradley BC, Perdue KS, Tisdel KA, et al. Frequency of anticoagulation for atrial fibrillation and reasons for its nonuse at a Veterans Affairs medical center. Am J Cardiol 2000; 85: 568-572
    • (2000) Am J Cardiol , vol.85 , pp. 568-572
    • Bradley, B.C.1    Perdue, K.S.2    Tisdel, K.A.3
  • 7
    • 0035725519 scopus 로고    scopus 로고
    • Is warfarin really underused in patients with atrial fibrillation?
    • Weisbord SD, Whittle J, Brooks RC. Is warfarin really underused in patients with atrial fibrillation? J Gen Intern Med 2001; 16: 743-749
    • (2001) J Gen Intern Med , vol.16 , pp. 743-749
    • Weisbord, S.D.1    Whittle, J.2    Brooks, R.C.3
  • 8
    • 3042760827 scopus 로고    scopus 로고
    • Risk factors for stroke and thromboprophylaxis in atrial fibrillation: What happens in daily clinical practice? the GEFAUR-1 study
    • on behalf of the Investigators in the Spanish Atrial Fibrillation in Emergency Medicine Study Group (GEFAUR)
    • Laguna P, Martýn A, del Arco C, et al., on behalf of the Investigators in the Spanish Atrial Fibrillation in Emergency Medicine Study Group (GEFAUR). Risk factors for stroke and thromboprophylaxis in atrial fibrillation: what happens in daily clinical practice? The GEFAUR-1 study. Ann Emerg Med 2004; 44: 3-11
    • (2004) Ann Emerg Med , vol.44 , pp. 3-11
    • Laguna, P.1    Martýn, A.2    Del Arco, C.3
  • 9
    • 0242351842 scopus 로고    scopus 로고
    • Risk of haemorrhagic stroke in patients with oral anticoagulation compared with the general population
    • Själander A, Engström G, Berntorp E, et al. Risk of haemorrhagic stroke in patients with oral anticoagulation compared with the general population. J Intern Med 2003; 254: 434-438
    • (2003) J Intern Med , vol.254 , pp. 434-438
    • Själander, A.1    Engström, G.2    Berntorp, E.3
  • 10
    • 0032862352 scopus 로고    scopus 로고
    • Major bleeding during anticoagulation after cerebral ischemia: Patterns and risk factors
    • Gorter JW. Major bleeding during anticoagulation after cerebral ischemia: patterns and risk factors. Neurology 1999; 53: 1319
    • (1999) Neurology , vol.53 , pp. 1319
    • Gorter, J.W.1
  • 11
    • 0034848607 scopus 로고    scopus 로고
    • Stroke prevention in atrial fibrillation: Physicians' attitudes to anticoagulation in older people
    • Vasishta S, Toor F, Johansen A, et al. Stroke prevention in atrial fibrillation: physicians' attitudes to anticoagulation in older people. Arch Gerontol Geriatr 2001; 33 (3): 219-226
    • (2001) Arch Gerontol Geriatr , vol.33 , Issue.3 , pp. 219-226
    • Vasishta, S.1    Toor, F.2    Johansen, A.3
  • 12
    • 0032720078 scopus 로고    scopus 로고
    • Variations in family physicians' and cardiologists' care for patients with heart failure
    • Baker DW, Hayes RP, Massie BM, et al. Variations in family physicians' and cardiologists' care for patients with heart failure. Am Heart J 1999; 138: 826-834
    • (1999) Am Heart J , vol.138 , pp. 826-834
    • Baker, D.W.1    Hayes, R.P.2    Massie, B.M.3
  • 13
    • 85088605863 scopus 로고    scopus 로고
    • Underuse of antithrombotic therapy in stroke patients with chronic atrial fibrillation response
    • Villa A, Bacchetta A, Omboni E, et al. Underuse of antithrombotic therapy in stroke patients with chronic atrial fibrillation response. Stroke 2000; 21: 2266-2278
    • (2000) Stroke , vol.21 , pp. 2266-2278
    • Villa, A.1    Bacchetta, A.2    Omboni, E.3
  • 14
    • 0346125424 scopus 로고    scopus 로고
    • Atrial fibrillation in a primary care practice: Prevalence and management
    • Ceresne L, Upshur RE. Atrial fibrillation in a primary care practice: prevalence and management. BMC Fam Prac 2002; 3: 11
    • (2002) BMC Fam Prac , vol.3 , pp. 11
    • Ceresne, L.1    Upshur, R.E.2
  • 15
    • 0003105577 scopus 로고
    • Undermedication among geriatric outpatients: Results of a randomized controlled trial
    • Lipton HL, Bero LA, Bird JA, et al. Undermedication among geriatric outpatients: results of a randomized controlled trial. Ann Rev Gerontol Ger 1992; 12: 95-108
    • (1992) Ann Rev Gerontol Ger , vol.12 , pp. 95-108
    • Lipton, H.L.1    Bero, L.A.2    Bird, J.A.3
  • 16
    • 0033548832 scopus 로고    scopus 로고
    • Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls
    • Man-Son-Hing M, Nichol G, Lau A, et al. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch Intern Med 1999; 159: 677-685
    • (1999) Arch Intern Med , vol.159 , pp. 677-685
    • Man-Son-Hing, M.1    Nichol, G.2    Lau, A.3
  • 17
    • 0037817710 scopus 로고    scopus 로고
    • Anticoagulant-related bleeding in older persons with atrial fibrillation: Physicians' fears often unfounded
    • Man-Son-Hing M, Laupacis A. Anticoagulant-related bleeding in older persons with atrial fibrillation: physicians' fears often unfounded. Arch Intern Med 2003; 163: 1580-1586
    • (2003) Arch Intern Med , vol.163 , pp. 1580-1586
    • Man-Son-Hing, M.1    Laupacis, A.2
  • 18
    • 0016823810 scopus 로고
    • "Mini-Mental State": A practical method for grading the cognitive state of patients for the clinician
    • Folstein MF, Folstein SE, McHugh PR. "Mini-Mental State": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198
    • (1975) J Psychiatr Res , vol.12 , pp. 189-198
    • Folstein, M.F.1    Folstein, S.E.2    McHugh, P.R.3
  • 19
    • 0023092594 scopus 로고
    • A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation
    • Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (5): 373-383
    • (1987) J Chronic Dis , vol.40 , Issue.5 , pp. 373-383
    • Charlson, M.E.1    Pompei, P.2    Ales, K.L.3
  • 20
    • 0028024127 scopus 로고
    • A summated score for the Medication Appropriateness Index: Development and assessment of clinimetric properties including content validity
    • Samsa GP, Hanlon JT, Schmader KE, et al. A summated score for the Medication Appropriateness Index: development and assessment of clinimetric properties including content validity. J Clin Epidemiol 1994; 47: 891-896
    • (1994) J Clin Epidemiol , vol.47 , pp. 891-896
    • Samsa, G.P.1    Hanlon, J.T.2    Schmader, K.E.3
  • 21
    • 0345600187 scopus 로고    scopus 로고
    • Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts
    • Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003; 163: 2716-2724
    • (2003) Arch Intern Med , vol.163 , pp. 2716-2724
    • Fick, D.M.1    Cooper, J.W.2    Wade, W.E.3
  • 22
    • 0035854054 scopus 로고    scopus 로고
    • Validation of clinical classification schemes for predicting strokes: Results from the National Registry of Atrial Fibrillation
    • Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting strokes: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285: 2864-2870
    • (2001) JAMA , vol.285 , pp. 2864-2870
    • Gage, B.F.1    Waterman, A.D.2    Shannon, W.3
  • 23
    • 16644398703 scopus 로고    scopus 로고
    • Effective anticoagulation therapy: Defining the gap between clinical studies and clinical practice
    • Wittkowsky AK. Effective anticoagulation therapy: defining the gap between clinical studies and clinical practice. Am J Manag Care 2004; 10 (10 Suppl.): S297-306
    • (2004) Am J Manag Care , vol.10 , Issue.10 SUPPL.
    • Wittkowsky, A.K.1
  • 24
    • 33645470121 scopus 로고    scopus 로고
    • Prevalence, incidence and lifetime risk of atrial fibrillation: The Rotterdam Study
    • Heeringa J, Van der Kuip DAM, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam Study. Eur Heart J 2006; 27: 949-953
    • (2006) Eur Heart J , vol.27 , pp. 949-953
    • Heeringa, J.1    Van Der Kuip, D.A.M.2    Hofman, A.3
  • 25
    • 84995360016 scopus 로고    scopus 로고
    • Atrial fibrillation management: A prospective survey in ESC member countries
    • The Euro Heart Survey on Atrial Fibrillation
    • Nieuwlaat R, Capucci A, Camm AJ, et al. Atrial fibrillation management: a prospective survey in ESC Member Countries. The Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005; 26: 2422-2434
    • (2005) Eur Heart J , vol.26 , pp. 2422-2434
    • Nieuwlaat, R.1    Capucci, A.2    Camm, A.J.3
  • 26
    • 0034116581 scopus 로고    scopus 로고
    • Adverse outcomes and predictors of underuse of antithrombotic therapy in Medicare beneficiaries with chronic atrial fibrillation
    • Gage BF, Boechler M, Doggette AL, et al. Adverse outcomes and predictors of underuse of antithrombotic therapy in Medicare beneficiaries with chronic atrial fibrillation. Stroke 2000; 31: 822-827
    • (2000) Stroke , vol.31 , pp. 822-827
    • Gage, B.F.1    Boechler, M.2    Doggette, A.L.3
  • 27
    • 0035080693 scopus 로고    scopus 로고
    • Oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and risk of bleeding: A multicenter inception cohort study
    • On behalf of the ISCOAT study
    • Pengo V, Legnani C, Noventa F, et al., on behalf of the ISCOAT study. Oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and risk of bleeding: a multicenter inception cohort study. Thromb Haemost 2001; 85: 418-422
    • (2001) Thromb Haemost , vol.85 , pp. 418-422
    • Pengo, V.1    Legnani, C.2    Noventa, F.3
  • 28
    • 17044428901 scopus 로고    scopus 로고
    • Factors affecting bleeding risk during anticoagulant therapy in patients with atrial fibrillation: Observations from the Atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study
    • DiMarco JP, Flaker G, Waldo AL, et al. Factors affecting bleeding risk during anticoagulant therapy in patients with atrial fibrillation: observations from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study. Am Heart J 2005; 149: 650-656
    • (2005) Am Heart J , vol.149 , pp. 650-656
    • Dimarco, J.P.1    Flaker, G.2    Waldo, A.L.3
  • 29
    • 19644400842 scopus 로고    scopus 로고
    • Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation
    • Fang MC, Chang Y, Hylek EM, et al. Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 2004; 141: 745-752
    • (2004) Ann Intern Med , vol.141 , pp. 745-752
    • Fang, M.C.1    Chang, Y.2    Hylek, E.M.3
  • 30
    • 33646152752 scopus 로고    scopus 로고
    • Comparison of bleeding in patients with nonvalvular atrial fibrillation treated with ximelagatran or warfarin
    • Douketis JD, Arneklev K, Goldhaber SZ, et al. Comparison of bleeding in patients with nonvalvular atrial fibrillation treated with ximelagatran or warfarin. Arch Intern Med 2006; 166: 853-859
    • (2006) Arch Intern Med , vol.166 , pp. 853-859
    • Douketis, J.D.1    Arneklev, K.2    Goldhaber, S.Z.3
  • 31
    • 34249715284 scopus 로고    scopus 로고
    • Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation
    • Hylek EM, Evans-Molina C, Shea C, et al. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 2007; 115: 2689-2696
    • (2007) Circulation , vol.115 , pp. 2689-2696
    • Hylek, E.M.1    Evans-Molina, C.2    Shea, C.3
  • 32
    • 0032505605 scopus 로고    scopus 로고
    • Prevalence of atrial fibrillation and eligibility for anticoagulants in the community
    • Sudlow M, Thomson R, Thwaites B, et al. Prevalence of atrial fibrillation and eligibility for anticoagulants in the community. Lancet 1998; 352: 167-171
    • (1998) Lancet , vol.352 , pp. 167-171
    • Sudlow, M.1    Thomson, R.2    Thwaites, B.3
  • 33
    • 18944367026 scopus 로고    scopus 로고
    • People aged over 75 in atrial fibrillation on warfarin: The rate of major hemorrhage and stroke in more than 500 patient-years of follow-up
    • Johnson CE, Lim WK, Workman BS. People aged over 75 in atrial fibrillation on warfarin: the rate of major hemorrhage and stroke in more than 500 patient-years of follow-up. J Am Geriatr Soc 2005; 53: 655-659
    • (2005) J Am Geriatr Soc , vol.53 , pp. 655-659
    • Johnson, C.E.1    Lim, W.K.2    Workman, B.S.3
  • 34
    • 3042712422 scopus 로고    scopus 로고
    • Anticoagulant use for atrial fibrillation in the elderly
    • Brophy MT, Snyder KR, Gaehde S, et al. Anticoagulant use for atrial fibrillation in the elderly. J Am Geriatr Soc 2004; 52: 1151-1156
    • (2004) J Am Geriatr Soc , vol.52 , pp. 1151-1156
    • Brophy, M.T.1    Snyder, K.R.2    Gaehde, S.3
  • 35
    • 17144372625 scopus 로고    scopus 로고
    • Antithrombotic therapy in atrial fibrillation: An assessment of compliance with guidelines
    • Nair A, Hazell W, Sutton T, et al. Antithrombotic therapy in atrial fibrillation: an assessment of compliance with guidelines. N Z Med J 2005; 118 (1208): U1258
    • (2005) N Z Med J , vol.118 , Issue.1208
    • Nair, A.1    Hazell, W.2    Sutton, T.3
  • 36
    • 33645828603 scopus 로고    scopus 로고
    • Translating the results of randomized trials into clinical practice: The challenge of warfarin candidacy among hospitalized elderly patients with atrial fibrillation
    • Hylek EM, D'Antonio J, Evans-Molina C, et al. Translating the results of randomized trials into clinical practice: the challenge of warfarin candidacy among hospitalized elderly patients with atrial fibrillation. Stroke 2006; 37: 1075-1080
    • (2006) Stroke , vol.37 , pp. 1075-1080
    • Hylek, E.M.1    D'Antonio, J.2    Evans-Molina, C.3
  • 37
    • 34547992312 scopus 로고    scopus 로고
    • Pre-admission stroke and atrial fibrillation: The appropriate use and barriers to oral anticoagulant therapy
    • Partington SL, Abid S, Teo K, et al. Pre-admission stroke and atrial fibrillation: the appropriate use and barriers to oral anticoagulant therapy. Thromb Res 2007; 120: 663-669
    • (2007) Thromb Res , vol.120 , pp. 663-669
    • Partington, S.L.1    Abid, S.2    Teo, K.3
  • 38
    • 52449119284 scopus 로고    scopus 로고
    • Which parameters differ in very old patients with chronic atrial fibrillation treated by anticoagulant or aspirin?
    • Doucet J, Gréboval-Furstenfeld E, Tavildari A, et al. Which parameters differ in very old patients with chronic atrial fibrillation treated by anticoagulant or aspirin? Fundam Clin Pharmacol 2008; 22 (5): 569-574
    • (2008) Fundam Clin Pharmacol , vol.22 , Issue.5 , pp. 569-574
    • Doucet, J.1    Gréboval-Furstenfeld, E.2    Tavildari, A.3
  • 39
    • 31144470462 scopus 로고    scopus 로고
    • Evaluation of survival and ischaemic and thromboembolic event rates in patients with nonvalvular atrial fibrillation in the general population when treated and untreated with warfarin
    • Currie CJ, Goodfellow J, McEwan P, et al. Evaluation of survival and ischaemic and thromboembolic event rates in patients with nonvalvular atrial fibrillation in the general population when treated and untreated with warfarin. Heart 2006; 92: 196-200
    • (2006) Heart , vol.92 , pp. 196-200
    • Currie, C.J.1    Goodfellow, J.2    McEwan, P.3
  • 40
    • 34547693119 scopus 로고    scopus 로고
    • Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial
    • DOI 10.1016/S0140-6736(07)61233-1, PII S0140673607612331
    • Mant J, Hobbs R, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007; 370: 493-503 (Pubitemid 47212371)
    • (2007) Lancet , vol.370 , Issue.9586 , pp. 493-503
    • Mant, J.1    Hobbs, F.R.2    Fletcher, K.3    Roalfe, A.4    Fitzmaurice, D.5    Lip, G.Y.6    Murray, E.7
  • 41
    • 33947413877 scopus 로고    scopus 로고
    • Thromboprophylaxis in octogenarians with atrial fibrillation: A randomised controlled trial of warfarin versus aspirin in octogenarians with atrial fibrillation (WASPO)
    • Rash A, Downes T, Portner R, et al. Thromboprophylaxis in octogenarians with atrial fibrillation: a randomised controlled trial of warfarin versus aspirin in octogenarians with atrial fibrillation (WASPO). Age Ageing 2007; 36: 151-156
    • (2007) Age Ageing , vol.36 , pp. 151-156
    • Rash, A.1    Downes, T.2    Portner, R.3
  • 42
    • 18544389260 scopus 로고    scopus 로고
    • Cognitive impairment as determinant for sub-optimal control of oral anticoagulation treatment in elderly patients with atrial fibrillation
    • Van Deelen BAJ, van den Bemt PMLA, Egberts TCG, et al. Cognitive impairment as determinant for sub-optimal control of oral anticoagulation treatment in elderly patients with atrial fibrillation. Drugs Aging 2005; 22 (4): 353-360
    • (2005) Drugs Aging , vol.22 , Issue.4 , pp. 353-360
    • Van Deelen, B.A.J.1    Van Den Bemt Pmla2    Egberts, T.C.G.3
  • 43
    • 49949112751 scopus 로고    scopus 로고
    • Reasons for underuse of oral anticoagulation in atrial fibrillation-associated stroke: Prospective study of German stroke patients [in German]
    • Reicke B, Masuhr F, Weih M. Reasons for underuse of oral anticoagulation in atrial fibrillation-associated stroke: prospective study of German stroke patients [in German]. Fortschr Neurol Psych 2008; 76 (7): 391-395
    • (2008) Fortschr Neurol Psych , vol.76 , Issue.7 , pp. 391-395
    • Reicke, B.1    Masuhr, F.2    Weih, M.3
  • 44
    • 33748066617 scopus 로고    scopus 로고
    • Stroke prophylaxis in atrial fibrillation: Who gets it and who does not? Report from the stockholm cohort study on atrial fibrillation
    • Friberg L, HammarN, Ringh M, et al. Stroke prophylaxis in atrial fibrillation: who gets it and who does not? Report from the Stockholm Cohort Study on Atrial Fibrillation. Eur Heart J 2006; 27: 1954-1964
    • (2006) Eur Heart J , vol.27 , pp. 1954-1964
    • Friberg, L.1    Hammarn Ringh, M.2
  • 45
    • 0344861847 scopus 로고    scopus 로고
    • Anticoagulation therapy for stroke prevention in atrial fibrillation: How well do randomized trial translate into clinical practice?
    • Go AS, Hylek EM, Chang Y, et al. Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trial translate into clinical practice? JAMA 2003; 290: 2685-2692
    • (2003) JAMA , vol.290 , pp. 2685-2692
    • Go, A.S.1    Hylek, E.M.2    Chang, Y.3


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.