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Stroke prophylaxis in critically-ill patients with new-onset atrial fibrillation

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Abstract

Despite a high incidence of new onset atrial fibrillation (NOAF) in critically ill patients and its association with short and long-term incidence of stroke, there is limited data assessing anticoagulation on hospital discharge in these patients. We retrospectively reviewed electronic medical records of all adult patients admitted to non-cardiac ICUs at our institution between January 2009 and March 2016. Patients with NOAF were identified and CHA2DS2-VASc score of ICU survivors was calculated. Prescription of oral anticoagulant therapy on hospital discharge was analyzed. A total of 640 (1.7% [38,708 patients]; 95% CI 1.5%, 1.8%) patients developed NOAF during the study period. CHA2DS2-VASc score was calculated for 615 patients, of which 82.2% had a CHA2DS2-VASc score ≥ 2. Of the 428 eligible patients, only 96 patients (22.4%) were discharged on oral anticoagulant therapy. Patients with a history of congestive heart failure (33.7% vs. 19.7%) and stroke/TIA or other thromboembolic disease (35.9% vs. 18.0%) were more likely to be discharged on an oral anticoagulant. Patients with a higher score were also more likely to be discharged on an oral anticoagulant (OR 1.27; 95% CI 1.10, 1.47). NOAF is common in critically ill patients admitted to non-cardiac ICUs and a significant proportion of these patients have a CHA2DS2-VASc score ≥ 2. However, only a minority of them are discharged on an oral anticoagulant. There is a need to identify ways to improve implementation of effective stroke prophylaxis in these patients.

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Authors and Affiliations

  1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA

    Robert S. Schoaps

  2. Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, P.O Box 850, MC H187, Hershey, PA, 17033, USA

    Anthony Bonavia, Zyad J. Carr & Kunal Karamchandani

  3. Department of Pharmacy, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Ashley Quintili

  4. Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Erik B. Lehman

  5. Center for Quality Innovation, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Thomas Abendroth

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  1. Robert S. Schoaps
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  2. Ashley Quintili
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Correspondence to Kunal Karamchandani.

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Schoaps, R.S., Quintili, A., Bonavia, A. et al. Stroke prophylaxis in critically-ill patients with new-onset atrial fibrillation. J Thromb Thrombolysis 48, 394–399 (2019). https://doi.org/10.1007/s11239-019-01854-5

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