ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2019
Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial fibrillation.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 32 citations in OpenAlex.
- Emergency Department Clinician Preferences in the Management of New-Onset Atrial Fibrillation.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- Article
- Cardioversion and the Risk of Subsequent Stroke or Systemic Embolism and Death in Emergency Department Patients With Acute Atrial Fibrillation or Flutter.Journal of the American College of Emergency Physicians open · 2025Article
- Modern management of acute atrial fibrillation and atrial flutter.Clinical and experimental emergency medicine · 2024Article
- Article
- Measuring and improving atrial fibrillation and flutter care in Canadian emergency departments.CJEM · 2024Article
- Emergency Department-to-Community Transitions of Care: Best Practices for the Older Adult Population.Clinics in geriatric medicine · 2023Review
- Trends in Atrial Fibrillation Management-Results from a National Multi-Center Urgent Care Network Registry.Journal of clinical medicine · 2023Article
- Article
- Eligibility and Implementation of Rivaroxaban for Secondary Prevention of Atherothrombosis in Clinical Practice-Insights From the CANHEART Study.Journal of the American Heart Association · 2022Article
- Emergency Department capacity to initiate thromboprophylaxis in patients with atrial fibrillation and thrombotic risk after discharge: URGFAICS cohort analysis.Internal and emergency medicine · 2022Article
- Article
- Oral anticoagulation for patients with atrial fibrillation in the ED: RE-LY AF registry analysis.Journal of thrombosis and thrombolysis · 2022Article
- Factors Associated with Anticoagulation Initiation for New Atrial Fibrillation in an Urban Emergency Department.Ethnicity & disease · 2022Article
- Review
- Artificial intelligence MacHIne learning for the detection and treatment of atrial fibrillation guidelines in the emergency department setting (AIM HIGHER): Assessing a machine learning clinical decision support tool to detect and treat non-valvular atrial fibrillation in the emergency department.Journal of the American College of Emergency Physicians open · 2021Article
- Medication Use Quality and Safety in Older Adults: 2019 Update.Journal of the American Geriatrics Society · 2021Review
- Assessment of an Algorithm for Prescription of Oral Anticoagulation for Patients With Atrial Fibrillation in Emergency Departments.JAMA network open · 2020Article
- Assessment of Anticoagulant Initiation in Patients With New-Onset Atrial Fibrillation During Emergency Department Visit-Point-by-Point Response.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPatients with atrial fibrillation frequently seek emergency care. Rates of guideline-concordant oral anticoagulant therapy for stroke prevention are suboptimal in the community. We assessed the association between prescribing of oral anticoagulants in the emergency department (relative to referral to a longitudinal care provider for treatment initiation) and long-term use of oral anticoagulants.
methodsThis retrospective cohort study performed at 15 hospitals in Ontario, Canada, involved patients aged 65 years or older who visited the emergency department between 2009 and 2014, who had a primary diagnosis of atrial fibrillation, were discharged home, and were eligible for and willing to take stroke-prevention therapy. We used inverse probability-of-treatment weighting based on the propensity score to compare patients who were and were not given a prescription for an oral anticoagulant. The primary outcome was a prescription fill for an oral anticoagulant 6 months later. Secondary outcomes included a prescription fill at 1 year, all-cause mortality, and strokes or bleeding events leading to hospital admission.
resultsOf 2132 eligible patients, 402 (18.9%) were given a prescription for an oral anticoagulant in the emergency department. After weighting, 67.8% of these patients had filled a prescription for an oral anticoagulant at 6 months versus 37.2% of those who did not receive a prescription in the emergency department (absolute risk increase [ARI] 30.6%, number needed to treat [NNT] 3). At 1 year, the ARI was 23.2% and the NNT was 4. Rates of death, stroke and bleeding events did not differ significantly.
interpretationIn patients with atrial fibrillation who were eligible for stroke prevention, prescribing an oral anticoagulant in the emergency department was associated with substantially higher long-term use of oral anticoagulants compared with deferring to the longitudinal care provider to initiate this therapy. Physicians working in the emergency department should consider initiating oral anticoagulation in eligible patients who are being discharged to home.
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