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Stroke. 2017 May;48(5):1344-1352. doi: 10.1161/STROKEAHA.116.014855. Epub 2017 Apr 7.

Benefits of Emergency Departments' Contribution to Stroke Prophylaxis in Atrial Fibrillation: The EMERG-AF Study (Emergency Department Stroke Prophylaxis and Guidelines Implementation in Atrial Fibrillation).

Author information

1
From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.). bcvinent@clinic.cat.
2
From the Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid, Spain (B.C.-V., A.M., J.S., C.S., F.M., M.V., M.C., S.S., J.C., C.d.A.); Atrial Fibrillation Unit (UFA) (B.C.-V.), and Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain (J.T.); Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona; Medical Statistics Core Facility, IDIBAPS (Hospital Clinic), Barcelona, Spain (J.R., G.C.); and Medical Department, Bayer Hispania-sl, Barcelona, Spain (C.R.).

Abstract

BACKGROUND AND PURPOSE:

Long-term benefits of initiating stroke prophylaxis in the emergency department (ED) are unknown. We analyzed the long-term safety and benefits of ED prescription of anticoagulation in atrial fibrillation patients.

METHODS:

Prospective, multicenter, observational cohort of consecutive atrial fibrillation patients was performed in 62 Spanish EDs. Clinical variables and thromboprophylaxis prescribed at discharge were collected at inclusion. Follow-up at 1 year post-discharge included data about thromboprophylaxis and its complications, major bleeding, and death; risk was assessed with univariate and bivariate logistic regression models.

RESULTS:

We enrolled 1162 patients, 1024 (88.1%) at high risk according to CHA2DS2-VASc score. At ED discharge, 935 patients (80.5%) were receiving anticoagulant therapy, de novo in 237 patients (55.2% of 429 not previously treated). At 1 year, 48 (4.1%) patients presented major bleeding events, and 151 (12.9%) had died. Anticoagulation first prescribed in the ED was not related to major bleeding (hazard ratio, 0.976; 95% confidence interval, 0.294-3.236) and was associated with a decrease in mortality (hazard ratio, 0.398; 95% confidence interval, 0.231-0.686). Adjusting by the main clinical and sociodemographic characteristics, concomitant antiplatelet treatment, or destination (discharge or admission) did not affect the results.

CONCLUSIONS:

Prescription of anticoagulation in the ED does not increase bleeding risk in atrial fibrillation patients at high risk of stroke and contributes to decreased mortality.

KEYWORDS:

anticoagulants; atrial fibrillation; hemorrhage; mortality stroke

PMID:
28389612
PMCID:
PMC5404399
DOI:
10.1161/STROKEAHA.116.014855
[Indexed for MEDLINE]
Free PMC Article

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