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Practice Gap in Atrial Fibrillation Oral Anticoagulation Prescribing at Emergency Department Home Discharge
Introduction: Current U.S. cardiology guidelines recommend oral anticoagulation (OAC) to reduce stroke risk in selected patients with atrial fibrillation (AF), but no formal AF OAC recommendations exist to guide emergency medicine clinicians in the acute care setting. We sought to characterize emergency department (ED) OAC prescribing practices after an ED AF diagnosis.Methods: This retrospective study included index visits for OAC-naive patients ≥18 years old who were discharged home from the ED at an urban, academic, tertiary hospital with a primary diagnosis of AF from 2012-2014. Five hypothesis-blinded, chart reviewe...
Source: Western Journal of Emergency Medicine - June 29, 2020 Category: Emergency Medicine Source Type: research

Association between acute heart failure and major cardiovascular events in atrial fibrillation patients presenting at the emergency department: an EMERG-AF ancillary study
Conclusions The coexistence of AHF in patients presenting with atrial fibrillation in ED is associated to a worse 1-year outcome mainly due to MACE, but does not impact in overall mortality.
Source: European Journal of Emergency Medicine - May 13, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Impella versus extracorporeal membrane oxygenation in cardiogenic shock: a systematic review and meta-analysis
Conclusions: In patients with CS, the use of Impella is associated with lower rates of in-hospital mortality, bleeding, and stroke than ECMO. Future randomized studies with adequate sample sizes are needed to confirm these findings.
Source: Shock - November 1, 2022 Category: Emergency Medicine Tags: Review Article Source Type: research

Direct oral anticoagulants in patients with a left-sided bioprosthetic heart valve: a systematic review and meta-analysis
AbstractTo compare the efficacy/effectiveness and safety of DOACs versus VKAs in patients with a previously and newly surgically implanted BHV with or without AF. A systematic search on MEDLINE and EMBASE was performed till November 2022. Treatment effects were estimated with relative risk (RR) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed with theI2 statistic. Four randomized controlled trials (RCTs), 2 subgroup analysis from ARISTOTLE and ENGAGE-AF-TIMI 48 and 4 observational studies were included for a total of 5808 patients, 1893 on DOACs and 3915 on VKAs. AF prevalence was 98.28%. In the o...
Source: Internal and Emergency Medicine - February 7, 2023 Category: Emergency Medicine Source Type: research

Rate-control versus Rhythm-control Strategies and Outcomes in Septuagenarians with Atrial Fibrillation: Shariff N, Desai R, Patel, K, et al. Am J Med 2013;126:887–93.
Using data based on a public-use copy of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, the authors analyzed a subgroup of 70–80-year-old patients to compare rhythm vs. rate-controlling strategies. Of the 4060 patients from the original trial, 2248 patients were 70–80 years of age; 1118 were in the rate control group. Propensity-matching scores were used for each of the 2248 patients and they were placed in a cohort of 937 pairs, balanced using 45 baseline characteristics. Outcomes were all-cause mortality as the primary end point and cause-specific mortality, all-cause and cause-s...
Source: The Journal of Emergency Medicine - February 27, 2014 Category: Emergency Medicine Authors: Justin McLean Tags: Abstracts Source Type: research

Dabigatran-related coagulopathy: when can we assume the effect has “worn off”?
This issue of American Journal of Emergency Medicine presents a timely report that should be noted by all practicing emergency physicians. Nzwalo et al [1] describe a 61-year-old man with nonvalvular atrial fibrillation, taking 150 mg dabigatran twice daily for stroke protection, who presented to their emergency department (ED) with an acute ischemic stroke (AIS). The patient had a normal creatinine clearance and a normal thrombin time (TT). He was treated with intravenous recombinant tissue plasminogen activator (rt-PA) with good neurologic outcome and no bleeding complications.
Source: The American Journal of Emergency Medicine - August 28, 2014 Category: Emergency Medicine Authors: Charles V. Pollack, Jerrold H. Levy, John Eikelboom, Jeffrey I. Weitz, Frank W. Sellke, Menno V. Huisman, Thorsten Steiner, Pieter Kamphuisen, Richard A. Bernstein Tags: Controversies Source Type: research

To treat or not to treat very elderly naïve patients with atrial fibrillation with vitamin K antagonists (VKA): results from the VENPAF cohort
Abstract Despite the recommendations in the guidelines, physicians still underuse warfarin in very elderly patients with non-valvular atrial fibrillation (NVAF). The risks of stroke and major bleeding both increase with age, but it is still not clear whether the beneficial effects of vitamin K antagonists (VKA) in preventing stroke outweigh the related bleeding risks in fragile, very elderly patients. The bleeding rates reported in real-world observational studies differ considerably. The aim of this study was to retrospectively assess the incidence of major bleeding in VKA-naïve patients over 80 years old w...
Source: Internal and Emergency Medicine - April 21, 2015 Category: Emergency Medicine Source Type: research

Why switch from warfarin to NOACs?
Abstract Several patients with non-valvular atrial fibrillation treated with warfarin or other vitamin-K antagonists (VKA) might benefit from switching to an oral non vitamin-K antagonist anticoagulant (NOAC). In the absence of randomised comparative trials of switching to NOACs versus maintaining VKA treatment, several considerations argue in favour of a switching strategy. First, there is conclusive evidence that haemorrhagic strokes and intracranial bleedings are much fewer in number with NOACs than with warfarin. The risk of intracranial bleeding is 52 % lower with NOACS than with warfarin, with extremes rang...
Source: Internal and Emergency Medicine - March 14, 2016 Category: Emergency Medicine Source Type: research

Dabigatran: Important Considerations in the Elderly
We read, with keen interest, the report by Dezman et  al. regarding the severity of bleeding and mortality in trauma patients taking dabigatran (1). Stroke physicians frequently prescribe non-vitamin K antagonist oral anticoagulants (NOAC) like dabigatran for stroke prevention in the context of nonvalvular atrial fibrillation. Although the introducti on of NOAC into clinical practice has been a major advance with reduction of monitoring requirement, there remains ongoing concern about the risk of bleeding and the absence of an antidote.
Source: The Journal of Emergency Medicine - March 23, 2017 Category: Emergency Medicine Authors: Jatinder S. Minhas, Amit K. Mistri Tags: Letter to the Editor Source Type: research

Systemic Thrombolysis, Catheter ‐Directed Thrombolysis and Anticoagulation for Intermediate‐Risk Pulmonary Embolism: A Simulation Modeling Analysis
ConclusionIn our model, for those eligible, CDT results in the largest number of QALYs for patients with intermediate‐risk PE, although it is relatively expensive and the absolute difference in QALYs between anticoagulation alone and CDT is small. Future studies that provide data on longitudinal quality‐of‐life outcomes of patients treated for PE and characteristics of CDT would be beneficial to augment model inputs, inform assumptions, and validate results.This article is protected by copyright. All rights reserved.
Source: Academic Emergency Medicine - June 26, 2017 Category: Emergency Medicine Authors: Christopher Kabrhel, Ayman Ali, Jin Choi, Chin Hur Tags: Original Contribution Source Type: research

Systemic Thrombolysis, Catheter-Directed Thrombolysis and Anticoagulation for Intermediate-Risk Pulmonary Embolism: A Simulation Modeling Analysis.
CONCLUSION: In our model, for those eligible, CDT results in the largest number of QALYs for patients with intermediate-risk PE, although it is relatively expensive and the absolute difference in QALYs between anticoagulation alone and CDT is small. Future studies that provide data on longitudinal quality-of-life outcomes of patients treated for PE and characteristics of CDT would be beneficial to augment model inputs, inform assumptions, and validate results. This article is protected by copyright. All rights reserved. PMID: 28650086 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - June 26, 2017 Category: Emergency Medicine Authors: Kabrhel C, Ali A, Choi J, Hur C Tags: Acad Emerg Med Source Type: research

Systemic Thrombolysis, Catheter ‐Directed Thrombolysis, and Anticoagulation for Intermediate‐risk Pulmonary Embolism: A Simulation Modeling Analysis
ConclusionIn our model, for those eligible, CDT results in the largest number of QALYs for patients with intermediate‐risk PE, although it is relatively expensive and the absolute difference in QALYs between anticoagulation alone and CDT is small. Future studies that provide data on longitudinal quality‐of‐life outcomes of patients treated for PE and characteristics of CDT would be beneficial to augment model inputs, inform assumptions, and validate results.
Source: Academic Emergency Medicine - September 13, 2017 Category: Emergency Medicine Authors: Christopher Kabrhel, Ayman Ali, Jin G. Choi, Chin Hur Tags: Original Contribution Source Type: research

Severe Symptoms, but a Truly Treatable Disease
​BY NOURA MAHDI; DARRON LEWIS; JEREMY OSBORNE; & AHMED RAZIUDDIN, MDA 73-year-old man was brought to the emergency department from his nursing home for rectal bleeding and anemia. The patient mentioned he had had episodes of bright red rectal bleeding and constipation for a few months. A colonoscopy had been done prior to the visit, which revealed a large intestine tumor and biopsy confirming adenocarcinoma. He was awaiting an appointment with his surgeon.The patient reported bloody rectal leakage, and a CBC done at the nursing home showed a hemoglobin level of 7.2. He also complained of dyspnea but denied any other ...
Source: The Case Files - March 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Sex-related differences in prevalence, treatment and outcomes in patients with atrial fibrillation
AbstractTo analyze sex-related differences about AF prevalence, use of OAC and outcomes focusing on the older age classes. We used administrative data of the Lombardy Region, describing period prevalence, use of OAC and outcomes from 2002 to 2014 for all patients diagnosed with AF. AF prevalence over the 2002 –2014 period was higher in males than in females (2.7% vs. 2.1%,p <  0.001), increasing with age. From 2003 to 2014, not treated AF patients decreased mostly in males (from 40.3 to 33.7% with respect to 43.7–39.8% in females). Age-stratified adjusted logistic regression analysis found that females were more...
Source: Internal and Emergency Medicine - June 25, 2019 Category: Emergency Medicine Source Type: research

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