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

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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 ± 9.6 years. 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.

Original languageEnglish
Pages (from-to)756-759
Number of pages4
JournalEuropean Journal of Internal Medicine
Volume20
Issue number8
DOIs
Publication statusPublished - Dec 2009

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Atrial Fibrillation
Observational Studies
Hospital Emergency Service
Anticoagulants
Therapeutics
Blood Platelets
Thromboembolism
Comorbidity
Cardiac Arrhythmias
Stroke

Keywords

  • Anti-thrombotic therapy
  • Atrial fibrillation
  • Haemorrhage
  • Oral anticoagulation
  • Stroke
  • Thromboembolism

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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title = "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 ± 9.6 years. 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 = "Anti-thrombotic therapy, Atrial fibrillation, Haemorrhage, Oral anticoagulation, Stroke, Thromboembolism",
author = "Angelo Rovellini and Christian Folli and Francesca Cardani and Valter Monzani",
year = "2009",
month = "12",
doi = "10.1016/j.ejim.2009.08.008",
language = "English",
volume = "20",
pages = "756--759",
journal = "European Journal of Internal Medicine",
issn = "0953-6205",
publisher = "Elsevier B.V.",
number = "8",

}

TY - JOUR

T1 - Thromboembolic and haemorrhagic events in permanent atrial fibrillation

T2 - Observational study in an emergency department

AU - Rovellini, Angelo

AU - Folli, Christian

AU - Cardani, Francesca

AU - Monzani, Valter

PY - 2009/12

Y1 - 2009/12

N2 - 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 ± 9.6 years. 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.

AB - 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 ± 9.6 years. 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.

KW - Anti-thrombotic therapy

KW - Atrial fibrillation

KW - Haemorrhage

KW - Oral anticoagulation

KW - Stroke

KW - Thromboembolism

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