New Onset Atrial Fibrillation and ED Anticoagulation.
This month one of our residents assigned to JC asked whether I typically send my new-onset atrial fibrillation (AF) patients, who I have successfully cardioverted, home on anticoagulant therapy. I was surprised by the question since, the majority of those patients fit very narrow criteria for cardioversion. Most are generally healthy, and all have had a definitive history of new onset AF with RVR. So, my short answer was “no”. Her experience however, is that some of our cardiology colleagues are recommending empiric treatment with oral anticoagulants to all AF patients who have been cardioverted in the ED suggesting that it may add protection against the dreaded complication, embolic stroke. Review of 2014 AHA A-Fib guidelines recommends applying validated risk stratification tools such as the CHADS2 and the CHA2DS2-VASc scores as well as patient-centered decision making when considering anti-thrombotics. This month’s articles will look at thrombo-embolic events in new-onset AF patients, prediction tools that help risk-stratify patients and how effective we are at applying those prediction tools. Looking forward to an interesting discussion.
Stiell IG et al, Outcomes for Emergency Department Patients with Recent-Onset Atrial Fibrillation and Flutter Treated in Canadian Hospitals. Ann Emerg Med. 2017 May;69(5):562-571 Appraisal
Airaksinen KE et al, Thromboembolic complications after cardioversion of acute atrial fibrillation: the FinCV (Finnish CardioVersion) study. J Am Coll Cardiol. 2013 Sep 24;62(13):1187-92. Appraisal
Scheuermeyer FX et al, Missed opportunities for appropriate anticoagulation among emergency department patients with uncomplicated atrial fibrillation or flutter. Ann Emerg Med. 2013 Dec;62(6):557-565 Appraisal