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
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Journal of the American Heart Association - 12(2023), 8 vom: 18. Apr., Seite e026681 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wilson, Graham [VerfasserIn] |
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| Links: |
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| Themen: |
Anticoagulants |
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| Anmerkungen: |
Date Completed 19.04.2023 Date Revised 01.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1161/JAHA.122.026681 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM355312069 |
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| 041 | |a eng | ||
| 100 | 1 | |a Wilson, Graham |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a 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 |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 19.04.2023 | ||
| 500 | |a Date Revised 01.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a anticoagulation | |
| 650 | 4 | |a emergency medicine | |
| 650 | 4 | |a stroke | |
| 650 | 4 | |a transient ischemic attack | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 700 | 1 | |a Sharma, Mukul |e verfasserin |4 aut | |
| 700 | 1 | |a Eagles, Debra |e verfasserin |4 aut | |
| 700 | 1 | |a Nemnom, Marie-Joe |e verfasserin |4 aut | |
| 700 | 1 | |a Sivilotti, Marco L A |e verfasserin |4 aut | |
| 700 | 1 | |a Émond, Marcel |e verfasserin |4 aut | |
| 700 | 1 | |a Stiell, Ian G |e verfasserin |4 aut | |
| 700 | 1 | |a Stotts, Grant |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Jacques |e verfasserin |4 aut | |
| 700 | 1 | |a Worster, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Morris, Judy |e verfasserin |4 aut | |
| 700 | 1 | |a Cheung, Ka Wai |e verfasserin |4 aut | |
| 700 | 1 | |a Jin, Albert Y |e verfasserin |4 aut | |
| 700 | 1 | |a Oczkowski, Wieslaw J |e verfasserin |4 aut | |
| 700 | 1 | |a Sahlas, Demetrios J |e verfasserin |4 aut | |
| 700 | 1 | |a Murray, Heather E |e verfasserin |4 aut | |
| 700 | 1 | |a Mackey, Ariane |e verfasserin |4 aut | |
| 700 | 1 | |a Verreault, Steve |e verfasserin |4 aut | |
| 700 | 1 | |a Camden, Marie Christine |e verfasserin |4 aut | |
| 700 | 1 | |a Yip, Samuel |e verfasserin |4 aut | |
| 700 | 1 | |a Teal, Philip |e verfasserin |4 aut | |
| 700 | 1 | |a Gladstone, David J |e verfasserin |4 aut | |
| 700 | 1 | |a Boulos, Mark I |e verfasserin |4 aut | |
| 700 | 1 | |a Chagnon, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Shouldice, Elizabeth |e verfasserin |4 aut | |
| 700 | 1 | |a Atzema, Clare |e verfasserin |4 aut | |
| 700 | 1 | |a Slaoui, Tarik |e verfasserin |4 aut | |
| 700 | 1 | |a Teitlebaum, Jeanne |e verfasserin |4 aut | |
| 700 | 1 | |a Wells, George A |e verfasserin |4 aut | |
| 700 | 1 | |a Nath, Avik |e verfasserin |4 aut | |
| 700 | 1 | |a Perry, Jeffrey J |e verfasserin |4 aut | |
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