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). Issue 5 (May 2017)

• Record Type: Journal Article
• Authors: Coll-Vinent, Blanca; Martín, Alfonso; Sánchez, Juan; Tamargo, Juan; Suero, Coral; Malagón, Francisco; Varona, Mercedes; Cancio, Manuel; Sánchez, Susana; Carbajosa, José; Ríos, José; Casanovas, Georgina; Ràfols, Carles; del Arco, Carmen; Agud, María; Aguilar, José; Aguirre, Alfons; de Simón Almela, Amparo; Almirall, Mercè; Álvarez, Oscar; Amador, Luis; Andueza, Juan Antonio; Aramburu, Francisco José; Ayala, Ignacio; Bajo, Ángel; Bilbaíno, Carlos; Calvo, Ricardo; Díaz, María Elena; Estévez, Maria Jesús; Flaño, Cristina; Fuenzalida, Carolina; Garcés, Cristina; García, María Teresa; García, Pedro; García-Castrillo, Luis; Gargallo, Carmen; Garrido, José Manuel; González, Juan; Herrero, Pablo; Jiménez, Eduardo; Jiménez, Gregorio; Lázaro, José; Lopetegui, Pedro; López, Ignacio; Lubillo, José Maria; Marchena, María José; Moya, Francisco; Mozota, Julián; Navarro, Francisco José; Palom, Xavier; Ochoa, Javier; Peiró, Ana María; Parra, Juan Manuel; Perea, Álvaro; Piñera, Pascual; Riambau, Pere; Richard, Fernando; Rodríguez, Belén; Rodríguez, Roberto; Ruiz, Eva; Ruiz, Francisco; Segarra, Ana Maria; Seijas, Carmen; Sesma, Javier; Soler, Wilfredo; Sousa, María del Mar; Torres, José Manuel; Trejo, Olga Maria; Vicente, José;
• Is Part Of: Stroke. Volume 48:Issue 5(2017)
• Publication Date: 2017-05
• Subjects: anticoagulants -- atrial fibrillation -- hemorrhage -- mortality stroke; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.116.014855
• Languages: English
• ISSNs: 0039-2499

Abstract

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 CHA2 DS2 -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. Abstract : Supplemental Digital Content is available in the text.