Stroke prophylaxis in critically-ill patients with new-onset atrial fibrillation

Schoaps, Robert S.; Quintili, Ashley; Bonavia, Anthony; Carr, Zyad J.; Lehman, Erik; Abendroth, Thomas W.; Karamchandani, Kunal

doi:10.1007/s11239-019-01854-5

Cited by 4 publications

(6 citation statements)

References 29 publications

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“…To date, bleeding scores had not been evaluated in critically ill patients. In our study, 79.2% of the included patients had a CHA2DS2-VASc score ≥ 2, similar to a previous study [22], and 26.6% of the included patients were identified to have a high risk of bleeding based on the HAS-BLED bleeding risk score. Less than half of the patients who had indications for anticoagulation therapy, as evaluated by these scores, received anticoagulation therapy.…”

Section: Comparison With Previous Studiessupporting

confidence: 87%

“…Although 82.2% of the critically ill patients with NOAF had a CHA2DS2-VASc score of ≥ 2 [22], this score did not consistently predict the risk of ischemic stroke and mortality in critically ill patients during hospitalization [21,33,34]. To date, bleeding scores had not been evaluated in critically ill patients.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…Previous studies have reported that anticoagulants were prescribed for less than 40% of critically ill patients with new-onset AF (NOAF) [18][19][20][21], although most critically ill patients were considered to be at high risk of ischemic stroke (CHA2DS2-VASc score ≥ 2) [22]. Although critically ill patients may have increased bleeding risks, only a few studies have evaluated clinical scores, including the HAS-BLED score, for predicting bleeding risk in critically ill patients with AF.…”

Section: Introductionmentioning

confidence: 99%

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Clinical prediction scores and early anticoagulation therapy for new-onset atrial fibrillation in critical illness: a post-hoc analysis

Sakuraya

Yoshida

Sasabuchi

et al. 2021

BMC Cardiovasc Disord

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Purpose This study sought to describe the epidemiology of anticoagulation therapy for critically ill patients with new-onset atrial fibrillation (NOAF) according to CHA2DS2-VASc and HAS-BLED scores and to assess the efficacy of early anticoagulation therapy. Method Adult patients who developed NOAF during intensive care unit stay were included. We compared the patients who were treated with and without anticoagulation therapy within 48 h from AF onset. The primary outcome was a composite outcome that included mortality and ischemic stroke during the period until hospital discharge. Results In total, 308 patients were included in this analysis. Anticoagulants were administered to 95 and 33 patients within 48 h and after 48 h from NOAF onset, respectively. After grouping the patients into four according to their CHA2DS2-VASc and HAS-BLED bleeding scores, we found that the proportion of anticoagulation therapy administered was similar among all groups. After adjustment using a multivariable Cox regression model, we noted that early anticoagulation therapy did not decrease the composite outcome (adjusted hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.47‒1.23). However, in patients without rhythm control drugs, early anticoagulation was significantly associated with better outcomes (adjusted HR 0.46; 95% CI; 0.22‒0.87, P = 0.041). Conclusions We found that clinical prediction scores were supposedly not used in the decision to implement anticoagulation therapy and that early anticoagulation therapy did not improve clinical outcomes in critically ill patients with NOAF. Trial registration UMIN-CTR UMIN000026401. Registered 5 March 2017.

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Section: Comparison With Previous Studiessupporting

confidence: 87%

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical prediction scores and early anticoagulation therapy for new-onset atrial fibrillation in critical illness: a post-hoc analysis

Sakuraya

Yoshida

Sasabuchi

et al. 2021

BMC Cardiovasc Disord

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“…2,3 Observational data suggest that AF related to critical illness is associated with adverse outcomes, including prolonged hospitalization, hemodynamic instability, increased risk of thromboembolic events and higher mortality rates. 4 The mechanisms by which AF is associated to worse outcomes are unknown, but may be due to hemodynamic instability, heart failure, stroke, or they may represent a marker of underlying pathophysiology that leads to worse outcomes. 2 Despite NOAF being common and associated with adverse outcomes, recently published studies have highlighted considerable practice variation in the management of NOAF in the intensive care unit (ICU).…”

Section: Discussionmentioning

confidence: 99%

“…2 Despite NOAF being common and associated with adverse outcomes, recently published studies have highlighted considerable practice variation in the management of NOAF in the intensive care unit (ICU). 2,[4][5][6] Moreover, the body of evidence informing the management of NOAF in critically ill patients is sparse, and specific clinical practice recommendations are missing. Current recommendations on the management of AF in critically ill patients are mainly derived from non-critically ill patient populations, 7 and it is questionable if these recommendations can be extrapolated to patients with organ failure(s) in the ICU.…”

Section: Discussionmentioning

confidence: 99%

New‐onset atrial fibrillation in critically ill adult patients—an SSAI clinical practice guideline

Andreasen

Wetterslev

Sigurdsson

et al. 2023

Acta Anaesthesiol Scand

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BackgroundAcute or new‐onset atrial fibrillation (NOAF) is the most common cardiac arrhythmia in critically ill adult patients, and observational data suggests that NOAF is associated to adverse outcomes.MethodsWe prepared this guideline according to the Grading of Recommendations Assessment, Development and Evaluation methodology. We posed the following clinical questions: (1) what is the better first‐line pharmacological agent for the treatment of NOAF in critically ill adult patients?, (2) should we use direct current (DC) cardioversion in critically ill adult patients with NOAF and hemodynamic instability caused by atrial fibrillation?, (3) should we use anticoagulant therapy in critically ill adult patients with NOAF?, and (4) should critically ill adult patients with NOAF receive follow‐up after discharge from hospital? We assessed patient‐important outcomes, including mortality, thromboembolic events, and adverse events. Patients and relatives were part of the guideline panel.ResultsThe quantity and quality of evidence on the management of NOAF in critically ill adults was very limited, and we did not identify any relevant direct or indirect evidence from randomized clinical trials for the prespecified PICO questions. We were able to propose one weak recommendation against routine use of therapeutic dose anticoagulant therapy, and one best practice statement for routine follow‐up by a cardiologist after hospital discharge. We were not able to propose any recommendations on the better first‐line pharmacological agent or whether to use DC cardioversion in critically ill patients with hemodynamic instability induced by NOAF. An electronic version of this guideline in layered and interactive format is available in MAGIC: https://app.magicapp.org/#/guideline/7197.ConclusionsThe body of evidence on the management of NOAF in critically ill adults is very limited and not informed by direct evidence from randomized clinical trials. Practice variation appears considerable.

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Vorhofflimmern bei nichtkardialen Infektionen und Sepsis

Rath

Niehues

Leitz

et al. 2019

Herzschr Elektrophys

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Stroke prophylaxis in critically-ill patients with new-onset atrial fibrillation

Cited by 4 publications

References 29 publications

Clinical prediction scores and early anticoagulation therapy for new-onset atrial fibrillation in critical illness: a post-hoc analysis

Clinical prediction scores and early anticoagulation therapy for new-onset atrial fibrillation in critical illness: a post-hoc analysis

New‐onset atrial fibrillation in critically ill adult patients—an SSAI clinical practice guideline

Vorhofflimmern bei nichtkardialen Infektionen und Sepsis

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