Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Hamilton Health Sciences, Hamilton, ON, Canada.
CJEM. 2021 May;23(3):325-329. doi: 10.1007/s43678-020-00054-y. Epub 2021 Jan 20.
Atrial fibrillation increases the risk of stroke, which can be mitigated by anticoagulant prescription. We evaluated local emergency physician anticoagulation practice for patients discharged from the emergency department with atrial fibrillation, along with 90-day incidence of stroke and major bleeding.
This was a health record review of patients diagnosed with new onset atrial fibrillation in two emergency departments between 2014 and 2017. We collected data on CHADS65 scores, contraindications to direct oral anticoagulant (DOAC) prescription and initiation of anticoagulation in the ED. Patient charts were reviewed for the diagnosis of stroke, transient ischemic attack (TIA), systemic embolism or major bleeding within 90 days.
We identified 399 patients, median age 68 (IQR 57-79), 213 (53%) male. Only 299/399 patients had an indication for anticoagulation (CHADS65-positive). Of these 299, 27 had a contraindication to or were already prescribed anticoagulation. 45/272 (17%, 95% confidence interval 12-22%) patients eligible for initiation of anticoagulation left the emergency department with a prescription for anticoagulation. During 90-day follow-up, seven patients had stroke or TIA. Four stroke/TIA patients had been eligible to start an anticoagulant but were not started, two left the emergency department with prescriptions for an anticoagulant and one patient had a contraindication to initiating anticoagulation in the emergency department. There were no major bleeding episodes.
Few eligible patients were prescribed anticoagulation and the 90-day stroke rate was high. Physicians should become familiar with the CAEP Acute AF Best Practices Checklist AF which offers guidance on anticoagulation prescription.
心房颤动会增加中风的风险，中风可以通过开抗凝药物来缓解。我们评估了从急诊科出院的伴有心房颤动的患者的当地急诊医师抗凝治疗实践，以及 90 天内中风和大出血的发生率。
这是对 2014 年至 2017 年期间两家急诊科新发心房颤动患者的病历回顾。我们收集了 CHADS65 评分、直接口服抗凝剂（DOAC）处方和急诊科开始抗凝的禁忌证的数据。患者病历记录了 90 天内中风、短暂性脑缺血发作（TIA）、系统性栓塞或大出血的诊断。
我们确定了 399 例患者，中位年龄为 68（IQR 57-79），213 例（53%）为男性。只有 299/399 例患者有抗凝指征（CHADS65 阳性）。在这 299 例中，有 27 例有抗凝禁忌证或已开始抗凝。在 272 例符合抗凝治疗条件的患者中，有 45 例（17%，95%置信区间 12-22%）在离开急诊科时开了抗凝药处方。在 90 天随访期间，有 7 例发生中风或 TIA。4 例中风/TIA 患者符合开始抗凝治疗的条件但未开始治疗，2 例离开急诊科时开了抗凝药处方，1 例在急诊科有抗凝治疗禁忌证。没有大出血事件。
有抗凝指征的患者中只有少数人开了抗凝药，90 天内中风发生率较高。医生应熟悉 CAEP 急性房颤最佳实践检查表 AF，该检查表提供了抗凝药物处方的指导。
