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Benefits of Emergency Departments’ Contribution to Stroke Prophylaxis in Atrial Fibrillation

2017; Lippincott Williams & Wilkins; Volume: 48; Issue: 5 Linguagem: Inglês

10.1161/strokeaha.116.014855

1524-4628

Blanca Coll‐Vinent, Alfonso Martı́n, Juan Carlos Martín‐Sánchez, Juan Tamargo, Coral Suero, Francisco Malagón, Mercedes Varona, Manuel Cancio, Susana Sánchez‐Fidalgo, José Carbajosa, José Ríos, Georgina Casanovas, Carles Ràfols, Carmen del Arco, María Agud, José Aguilar, Alfons Aguirre, Amparo de Simón Almela, Mercè Almirall, Oscar Álvarez, Luis F. Amador, Juan Antonio Andueza, Francisco José Aramburu, Ignacio Ayala, Ángel Bajo Bajo, Carlos Bilbaíno, Ricardo Calvo, María Elena Aradas Díaz, Maria Jesús Estévez, Cristina Flaño, Carolina Fuenzalida, Cristina Garcés, María Teresa García, Pedro O. Ordúñez García, Luis Garcı́a-Castrillo, C. Lara Gargallo, José Manuel Garrido, Juan Marcos González, Pablo Herrero, Eduardo García Jiménez, Gregorio Jiménez, José Lázaro, Pedro Lopetegui, José I. López, José Maria Lubillo, M. Marchena, Francisco Moya, J. Mozota, Francisco José Navarro, Xavier Palom, Javier Ochoa, Ana M. Peiró, Juan Manuel Soto Parra, Álvaro F. Perea, Pascual Piñera, Pere Riambau, Fernando Richard, Belén Rodríguez, Roberto Fernández Rodríguez, Eva Ruiz, Francisco Ruiz, Ana María Vico Segarra, Carmen Seijas, Javier Sesma, Wilfredo Soler, María del Mar Sousa, Ferrán Torres, Olga Trejo, J. Vicente,

Venous Thromboembolism Diagnosis and Management

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.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.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.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.