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.
Key Words
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