Benefits of Emergency Departments' Contribution to Stroke Prophylaxis in Atrial Fibrillation
Coll-Vinent, Blanca (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Martín, Alfonso (Spanish Society of Emergency Medicine (SEMES))
Sánchez, Juan (Spanish Society of Emergency Medicine (SEMES))
Tamargo, Juan (Universidad Complutense de Madrid)
Suero, Coral (Spanish Society of Emergency Medicine (SEMES))
Malagón, Francisco (Spanish Society of Emergency Medicine (SEMES))
Varona, Mercedes (Spanish Society of Emergency Medicine (SEMES))
Cancio, Manuel (Spanish Society of Emergency Medicine (SEMES))
Sánchez, Susana (Spanish Society of Emergency Medicine (SEMES))
Carbajosa, José (Spanish Society of Emergency Medicine (SEMES))
Ríos, José (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva i Salut Pública)
Casanovas Mateu, Georgina (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Ràfols, Carles (Spanish Society of Emergency Medicine (SEMES))
del Arco, Carmen (Spanish Society of Emergency Medicine (SEMES))

Data:	2017
Resum:	Supplemental Digital Content is available in the text. 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 CHADS-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.
Nota:	Altres ajuts: The study was supported by a grant from Bayer Hispania, which had no influence on the content of the article
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Anticoagulants ; Atrial fibrillation ; Hemorrhage ; Mortality stroke
Publicat a:	Stroke, Vol. 48 (april 2017) , p. 1344-1352, ISSN 1524-4628

DOI: 10.1161/STROKEAHA.116.014855
PMID: 28389612

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