Ninety-Day Stroke or Transient Ischemic Attack Recurrence in Patients Prescribed Anticoagulation in the Emergency Department With Atrial Fibrillation and a New Transient Ischemic Attack or Minor Stroke.
Graham WilsonMukul SharmaDebra EaglesMarie-Joe NemnomMarco L A SivilottiMarcel ÉmondIan G StiellGrant StottsJacques Simon LeeAndrew WorsterJudy MorrisKa Wai CheungAlbert Y JinWieslaw J OczkowskiDemetrios J SahlasHeather E MurrayAriane MackeySteve VerreaultMarie-Christine CamdenSamuel YipPhilip TealDavid J GladstoneMark Iskander BoulosNicolas ChagnonElizabeth ShouldiceClare L AtzemaTarik SlaouiJeanne TeitelbaumGeorge A WellsAvik NathJeffery J PerryPublished in: Journal of the American Heart Association (2023)
Background For patients with atrial fibrillation seen in the emergency department (ED) following a transient ischemic attack (TIA) or minor stroke, the impact of initiating oral anticoagulation immediately rather than deferring the decision to outpatient follow-up is unknown. Methods and Results We conducted a planned secondary data analysis of a prospective cohort of 11 507 adults in 13 Canadian EDs between 2006 and 2018. Patients were eligible if they were aged 18 years or older, with a final diagnosis of TIA or minor stroke with previously documented or newly diagnosed atrial fibrillation. The primary outcome was subsequent stroke, recurrent TIA, or all-cause mortality within 90 days of the index TIA diagnosis. Secondary outcomes included stroke, recurrent TIA, or death and rates of major bleeding. Of 11 507 subjects with TIA/minor stroke, atrial fibrillation was identified in 11.2% (1286, mean age, 77.3 [SD 11.1] years, 52.4% male). Over half (699; 54.4%) were already taking anticoagulation, 89 (6.9%) were newly prescribed anticoagulation in the ED. By 90 days, 4.0% of the atrial fibrillation cohort had experienced a subsequent stroke, 6.5% subsequent TIA, and 2.6% died. Results of a multivariable logistic regression indicate no association between prescribed anticoagulation in the ED and these 90-day outcomes (composite odds ratio, 1.37 [95% CI, 0.74-2.52]). Major bleeding was found in 5 patients, none of whom were in the ED-initiated anticoagulation group. Conclusions Initiating oral anticoagulation in the ED following new TIA was not associated with lower recurrence rates of neurovascular events or all-cause mortality in patients with atrial fibrillation.
Keyphrases
- atrial fibrillation
- emergency department
- oral anticoagulants
- newly diagnosed
- catheter ablation
- left atrial
- left atrial appendage
- direct oral anticoagulants
- heart failure
- end stage renal disease
- percutaneous coronary intervention
- ejection fraction
- cerebral ischemia
- chronic kidney disease
- prognostic factors
- machine learning
- acute coronary syndrome
- venous thromboembolism
- mitral valve
- oxidative stress
- blood brain barrier
- subarachnoid hemorrhage
- ischemia reperfusion injury
- big data
- metabolic syndrome
- artificial intelligence
- coronary artery disease
- deep learning