Deans' stroke musings: Emergency Medicine Physician Attitudes toward Anticoagulant Initiation for Patients with Atrial Fibrillation

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, December 1, 2020

Emergency Medicine Physician Attitudes toward Anticoagulant Initiation for Patients with Atrial Fibrillation

You'll just have to hope your ER doctors ask you whether you are willing to take the risks.

Emergency Medicine Physician Attitudes toward Anticoagulant Initiation for Patients with Atrial Fibrillation

Published:November 24, 2020DOI:https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105474

Abstract

Background and Aim

Guidelines for the primary prevention of stroke recognize the emergency department as a location for physicians to identify atrial fibrillation and to initiate oral anticoagulants. Numerous studies have shown low anticoagulant prescription rates—approximately 18%—in OAC-naïve patients with atrial fibrillation discharged from the emergency department. We sought to obtain the opinions of Emergency Medicine physicians regarding anticoagulant decision-making for patients with atrial fibrillation seen in the emergency department.

Methods

14-item paper surveys were distributed to emergency department physicians within a single hospital system. The survey consisted of single-, multi- answer and open-ended questions regarding knowledge and usage frequency of the CHA ₂DS ₂-VASc score, knowledge of anticoagulant options and reasons for why an anticoagulant was not initiated.

Results

55 emergency department physicians completed the survey (overall response rate 59%). 89% (49/55) agreed the emergency department is an important location to initiate anticoagulation depending on comorbidities. A lower proportion reported ever starting a patient in the emergency department on a new anticoagulant prescription upon discharge (55% (30/55) p <.0001). The belief that a new anticoagulant prescription is the responsibility of the PCP/ Cardiologist/ Neurologist (52%; 15/29), not wanting to be held responsible in the event of a life-threatening bleeding event (41%; 12/29), and concerns about inadequate follow-up and/or lack of insurance (24%; 7/29) were the most commonly cited reasons for not starting an appropriate patient with atrial fibrillation on an anticoagulant.

Conclusion

Emergency Medicine physicians support initiating oral anticoagulants in the ED for patients with atrial fibrillation; however, discrepancies exist between their intentions and actual practice.