Afib: oral anticoagulant initiation in ED improves adherence

  • CMAJ

  • von Jenny Blair, MD
  • Clinical Essentials
Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten. Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten.

Takeaway

  • After treating patients in the emergency department (ED) for Afib, emergency physicians should consider initiating a prescription for oral anticoagulants.
  • Patients are much likelier to be taking these medications months later if a prescription is issued in the ED.

Why this matters

  • Afib rates are rising worldwide.
  • After an Afib-related ED encounter, about two-thirds of Canadian patients are discharged home.
  • Primary care providers and cardiologists typically decide whether to start oral anticoagulants to prevent stroke.
  • Not enough people with Afib who would potentially benefit from these drugs are taking them. 

Key results

  • 18.9% (402) had oral anticoagulant prescription issued in ED, 73.6% of which were written by emergency physician rather than consultant.
  • Proportions filling prescription at 6 months:
    • After ED prescription: 67.8%.
    • Without ED prescription: 37.2%.
    • Absolute risk increase, 30.6%.
    • Number needed to treat: 3.
  • Death, stroke, bleeding rates similar between groups.

Study design

  • 15-hospital retrospective cohort study of elderly patients being discharged from EDs in Ontario, Canada, with primary diagnosis of Afib/Aflutter, 2009-2014 (n=2132).
  • All were eligible for oral anticoagulants.
  • Authors compared outcomes in those with vs without ED-initiated prescription.
  • Outcome: filled prescription 6 months later.
  • Funding: Canadian Institutes for Health Research.

Limitations

  • Low event rates.