Summary
Clinical impact of new approaches to oral anticoagulation therapy in atrial fibrillation
Affiliation of the authors
DOI
Quote
De Azúa Jiménez M, Gómez Bitrián J, Royo Hernández R, Aldea Molina E, Llera Guerra R, Miranda Harto P. Clinical impact of new approaches to oral anticoagulation therapy in atrial fibrillation. Emergencias. 2009;21:405-9
Summary
Objective: To describe the oral anticoagulation therapy received by patients with atrial
fibrillation (AF) admitted in an Emergency Department Observation Unit (OU) and to
determine the adjusting degree of this therapy to the indications included in the
American Heart Association (AHA) protocols 2001 and 2006, and also the impact that it
has in the adjusting percentage of the indication change that has existed during this
period.
Method: Observational, prospective and no interventional trial. Patients admitted in an
OU diagnosed of AF for a 3 years consecutive period were included. General clinical data
were taken and from the most relevant AF and from the anticoagulant-antiplatelet
treatment prescribed when the patients were discharged from the OU. The adjusting
degree of this treatment was checked to both AHA protocols and the change percentage
in the indications that has implied the indication change of these guides.
Results: 789 patients were included (average age 67 years, 52% women): 90 (12%)
corresponding to chronic AF, 262 (33%) to first episodes and 436 (55%) to paroxystic AF.
From 185 patients with AF first episode discharged from de OU, 61 were prescribed with
anticoagulant therapy. From these, 52 were discharged with controlled AF (100% well
decoagulated, according to both guides) and 9 with sinusal rate (100% well decoagulated
according to the 2001 guides, but 55% according to the 2006 guides). From the 370
patients with paroxystic AF discharged, 167 (45%) were decoagulated, although according
to the 2001 guides should have been 54% (9% more than carried out in the OU) and
according to the 2006 guides 28% (17% less than carried out in the OU).
Conclusion: Anticoagulant prescription in AF in an Emergency Department doesn’t
adjust exactly to recommended in AHA guides, although the criteria changes produced
in those make possible a change from an undertreatment situation to another one of
overtreatment.
