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. 2023 Apr 18;12(8):e026681.
doi: 10.1161/JAHA.122.026681. Epub 2023 Apr 7.

Ninety-Day Stroke or Transient Ischemic Attack Recurrence in Patients Prescribed Anticoagulation in the Emergency Department With Atrial Fibrillation and a New Transient Ischemic Attack or Minor Stroke

Graham Wilson  1 , Mukul Sharma  2 , Debra Eagles  1   3 , Marie-Joe Nemnom  3 , Marco L A Sivilotti  4 , Marcel Émond  5   6 , Ian G Stiell  1   3 , Grant Stotts  7 , Jacques Lee  8   9 , Andrew Worster  10 , Judy Morris  11 , Ka Wai Cheung  12 , Albert Y Jin  13 , Wieslaw J Oczkowski  2 , Demetrios J Sahlas  2 , Heather E Murray  4 , Ariane Mackey  5   14 , Steve Verreault  5   14 , Marie Christine Camden  5   14 , Samuel Yip  15 , Philip Teal  15 , David J Gladstone  16 , Mark I Boulos  16 , Nicolas Chagnon  17 , Elizabeth Shouldice  18 , Clare Atzema  9 , Tarik Slaoui  11 , Jeanne Teitlebaum  11 , George A Wells  3 , Avik Nath  1 , Jeffrey J Perry  1   3
Affiliations

Ninety-Day Stroke or Transient Ischemic Attack Recurrence in Patients Prescribed Anticoagulation in the Emergency Department With Atrial Fibrillation and a New Transient Ischemic Attack or Minor Stroke

Graham Wilson et al. J Am Heart Assoc. .

Abstract

Background For patients with atrial fibrillation seen in the emergency department (ED) following a transient ischemic attack (TIA) or minor stroke, the impact of initiating oral anticoagulation immediately rather than deferring the decision to outpatient follow-up is unknown. Methods and Results We conducted a planned secondary data analysis of a prospective cohort of 11 507 adults in 13 Canadian EDs between 2006 and 2018. Patients were eligible if they were aged 18 years or older, with a final diagnosis of TIA or minor stroke with previously documented or newly diagnosed atrial fibrillation. The primary outcome was subsequent stroke, recurrent TIA, or all-cause mortality within 90 days of the index TIA diagnosis. Secondary outcomes included stroke, recurrent TIA, or death and rates of major bleeding. Of 11 507 subjects with TIA/minor stroke, atrial fibrillation was identified in 11.2% (1286, mean age, 77.3 [SD 11.1] years, 52.4% male). Over half (699; 54.4%) were already taking anticoagulation, 89 (6.9%) were newly prescribed anticoagulation in the ED. By 90 days, 4.0% of the atrial fibrillation cohort had experienced a subsequent stroke, 6.5% subsequent TIA, and 2.6% died. Results of a multivariable logistic regression indicate no association between prescribed anticoagulation in the ED and these 90-day outcomes (composite odds ratio, 1.37 [95% CI, 0.74-2.52]). Major bleeding was found in 5 patients, none of whom were in the ED-initiated anticoagulation group. Conclusions Initiating oral anticoagulation in the ED following new TIA was not associated with lower recurrence rates of neurovascular events or all-cause mortality in patients with atrial fibrillation.

Keywords: anticoagulation; emergency medicine; stroke; transient ischemic attack.

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Figures

Figure 1
Figure 1. Consort diagram of patients from 13 Canadian EDs over a 12‐year period with TIA or minor stroke as their final ED diagnosis.
AF indicates atrial fibrillation; ED, emergency department; and TIA, transient ischemic attack.
Figure 2
Figure 2. Rates of anticoagulant prescription and outcomes by year.
ED indicates emergency department; and TIA, transient ischemic attack.
See this image and copyright information in PMC

References

    1. Hill MD, Yiannakoulias N, Jeerakathil T, Tu JV, Svenson LW, Schopflocher DP. The high risk of stroke immediately after transient ischemic attack. Neurology. 2004;62:2015–2020. doi: 10.1212/01.WNL.0000129482.70315.2F - DOI - PubMed
    1. Wu CM, McLaughlin K, Lorenzetti DL, Hill MD, Manns BJ, Ghali WA. Early risk of stroke after transient ischemic attack: a systematic review and meta‐analysis. Arch Intern Med. 2007;167:2417–2422. doi: 10.1001/archinte.167.22.2417 - DOI - PubMed
    1. Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta‐analysis. Lancet. 2007;6:1063–1072. doi: 10.1016/S1474-4422(07)70274-0 - DOI - PubMed
    1. Lovett JK, Dennis MS, Sandercock PAG, Bamford J, Warlow CP, Rothwell PM. Very early risk of stroke after a first transient ischemic attack. Stroke. 2003;34:e138–e142. doi: 10.1161/01.STR.0000080935.01264.91 - DOI - PubMed
    1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991;22:983–988. doi: 10.1161/01.STR.22.8.983 - DOI - PubMed

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