Clinical impact of new approaches to oral anticoagulation therapy in atrial fibrillation

Objective: To describe the oral anticoagulation therapy received by patients with atrial fibrillation (AF) admitted in an Emergency Department Observation Unit (OU) and to determine the adjusting degree of this therapy to the indications included in the American Heart Association (AHA) protocols 2001 and 2006, and also the impact that it has in the adjusting percentage of the indication change that has existed during this period. Method: Observational, prospective and no interventional trial. Patients admitted in an OU diagnosed of AF for a 3 years consecutive period were included. General clinical data were taken and from the most relevant AF and from the anticoagulant-antiplatelet treatment prescribed when the patients were discharged from the OU. The adjusting degree of this treatment was checked to both AHA protocols and the change percentage in the indications that has implied the indication change of these guides. Results: 789 patients were included (average age 67 years, 52% women): 90 (12%) corresponding to chronic AF, 262(33%) to first episodes and 436 (55%) to paroxystic AF. From 185 patients with AF first episode discharged from de OU,61 were prescribed with anticoagulant therapy. From these, 52 were discharged with controlled AF (100% welldecoagulated, according to both guides) and 9 with sinusal rate (100% well decoagulated according to the 2001guides, but 55% according to the 2006 guides). From the 370 patients with paroxystic AF discharged, 167 (45%) weredecoagulated, although according to the 2001 guides should have been 54% (9% more than carried out in the OU) and according to the 2006 guides 28% (17% less than carried out in the OU).Conclusion: Anticoagulant prescription in AF in an Emergency Department doesn’t adjust exactly to recommended in AHA guides, although the criteria changes produced in those make possible a change from an under treatment situationto another one of overtreatment (AU)