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)

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

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    13 Citations (Scopus)

    Abstract

    © 2017 The Authors. 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.
    Original languageEnglish
    Pages (from-to)1344-1352
    JournalStroke
    Volume48
    Issue number5
    DOIs
    Publication statusPublished - 1 May 2017

    Keywords

    • anticoagulants
    • atrial fibrillation
    • hemorrhage
    • mortality stroke

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