Thromboembolic and haemorrhagic events in permanent atrial fibrillation: Observational study in an emergency department

Abstract 

Background

Atrial fibrillation (AF) is the most common arrhythmia in patients admitted to Emergency Departments. However, the management of permanent AF in order to prevent thromboembolism in clinical practice is still widely discussed. We aimed to evaluate this management and the occurrence of clinical events in a cohort of patients with permanent AF admitted to our Emergency Department.

Methods

We enrolled in this observational study 582 patients with permanent AF consecutively seen in our Emergency Room.

Results

Mean age was 80.1±9.6years. Two or more comorbidities were present in 67% of patients. 28% of patients were treated with oral anticoagulant therapy (OT) at the time of admission to the Emergency Department, 34.2% with anti-platelet therapy (APT), while 37.8% were taking no anti-thrombotic therapy. There was no correspondence between three observed groups of treatment and the risk stratification according to CHADS2. In the groups of patients at high or intermediate risk a higher number of ischemic stroke was observed in patients taking APT than in OT patients (16.1% vs 31.5%, p=0.001). A low frequency of total and cerebral haemorrhagic events was observed in all groups. Only the non severe bleeds were significantly more frequent in patients on OT.

Conclusions

OT is well-tolerated even in elderly patients, with a low rate of haemorrhagic events. In clinical practice OT is underused, in particular in older patients, in spite of a high number of thrombotic events.

Keywords: Atrial fibrillation, Thromboembolism, Oral anticoagulation, Anti-thrombotic therapy, Haemorrhage, Stroke