Antithrombotic therapy for prevention of stroke in clinical practice in the ED

Asia Kogan, Reuma Shapira, Ada Tamir, Gad Rennert
American Journal of Emergency Medicine 2007, 25 (1): 1-5

OBJECTIVE: The objective of this study was to analyze the emergency medicine department's practice of recommending anticoagulation medication for stroke prevention, its compliance with clinical guidelines, and the role of the emergency physician in recommending anticoagulation medication. We also determined the occurrence of thromboembolic events in patients with atrial fibrillation (AF) during a follow-up period of up to 8 months after their discharge from the ED.

MATERIALS AND METHODS: Over a 6-month period, patients presenting to the ED with AF were registered using a predesigned 2-part questionnaire. The first part considered the management of the patients with AF at the ED; the second part evaluated data on patients who returned to the ED and their treatment follow-up, based on the drug supply registry.

RESULTS: This study included 102 ED visits by patients with AF, of whom 38 were hospitalized and 64 were discharged. Thirty-six of the discharged patients required anticoagulation according to American College of Cardiology/American Heart Association Task Force on Practice Guidelines/European Society of Cardiology guidelines. Of these patients, 28 (78%) were recommended anticoagulation medication and 8 (25%) were not: 5 because of contraindications and 3 because of unknown reasons. No patient returned to the ED with a thromboembolic event during the 8-month follow-up period.

CONCLUSION: The prevalence of anticoagulation recommendation for stroke prevention and compliance with clinical guidelines were found to be greater than previously reported. Our data show that most of the patients with AF and risk factors for stroke were recommended anticoagulation medication. This study illustrates the importance of applying clinical guidelines in daily practice and integrating them into patients' medical files in the ED.

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