• Media type: E-Article
  • Title: 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) : The EMERG-AF Study (Emergency Department Stroke Prophylaxis and Guidelines Implementation in Atrial Fibrillation)
  • Contributor: 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; [...]
  • imprint: Ovid Technologies (Wolters Kluwer Health), 2017
  • Published in: Stroke
  • Language: English
  • DOI: 10.1161/strokeaha.116.014855
  • ISSN: 0039-2499; 1524-4628
  • Keywords: Advanced and Specialized Nursing ; Cardiology and Cardiovascular Medicine ; Neurology (clinical)
  • Origination:
  • Footnote:
  • Description: <jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> We enrolled 1162 patients, 1024 (88.1%) at high risk according to CHA <jats:sub>2</jats:sub> DS <jats:sub>2</jats:sub> -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. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>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.</jats:p> </jats:sec>
  • Access State: Open Access