Revista Científica de la Sociedad Española de Medicina de Urgencias y Emergencias
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5.5
1er cuartil (4 de 32)
Emergency Medicine
Resumen
Original article
252-60
August
2023
252
260
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Sex-related differences in benefits of anticoagulation therapy in elderly patients with atrial fibrillation: a subanalysis of the EMERG-AF study
Varona M, Martín A, Sánchez J, Tamargo J, Cancio M, Sánchez S, Fernández de Simón A, Ríos J, Del Arco C, Ormaetxe J, Suero C, Coll-Vinent B
Grupo de Arritmias Cardiacas y Síncope de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Spain. Servicio de Urgencias, Hospital Universitario de Basurto, Universidad del País Vasco, Bilbao, Spain. Servicio de Urgencias, Hospital Universitario de Móstoles, Madrid, Spain. Servicio de Urgencias, Hospital Universitario Virgen de las Nieves, Granada, Spain. Departamento de Farmacología, CIBERCV, Universidad Complutense, Madrid, Spain. Servicio de Urgencias, Hospital Universitario Donostia, San Sebastián, Spain. Servicio de Urgencias, Hospital Universitario Río Hortega, Universidad de Valladolid, Spain. Servicio de Urgencias, Hospital Universitario de Alicante Dr Balmis, Alicante, Spain. Servicio de Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Laboratorio de Bioestadística y Epidemiología, Universitat Autònoma de Barcelona, Spain. Servicio de Urgencias, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Spain. Servicio de Cardiología, Hospital Universitario de Basurto, Universidad del País Vasco, Bilbao, Spain. Área de Urgencias y Cuidados Críticos, Hospital de la Axarquía, Vélez-Málaga, Spain. Área de Urgencias. Grup de Recerca “Urgències: processos i patologies”. IDIBAPS. Unitat de Fibrillació Auricular (UFA). Hospital Clínic. Barcelona, Spain.
Objectives. To analyze the long-term benefits and safety of oral anticoagulation therapy prescribed in emergency departments for elderly patients with atrial fibrillation, and to detect any sex-related differences present.
Methods. Post-hoc analysis of data compiled by the EMERG-AF group (Spanish acronym for Emergency Department Stroke Prophylaxis and Guidelines Implementation in Atrial Fibrillation). Consecutive patients aged 75 years or older with atrial fibrillation who were treated in 62 EDs were included. We recorded clinical data and anticoagulants prescribed. Patients were followed for 1 year. The main outcome variable was a composite of death, thromboembolism, or major bleeding within 1 year.
Results. Data for 690 patients were registered; 386 (55.9%) were women. At discharge, 575 patients (83.3%) were on anticoagulants; therapy was started in the ED for 96 of them. A total of 158 patients (22.9%) had experienced at least 1 component of the main outcome within 1 year: 118 (17.1%) died, 22 (2.7%) had thromboembolic complications, and 34 (4.9%) had major bleeding. After adjustment for main clinical characteristics, hazard ratios (HRs) showed that anticoagulation therapy was associated with a reduction in the composite outcome (HR, 0.372; 95% CI, 0.236-0.587; P < .001) but not specifically with major bleeding overall. When data for women were analyzed separately, anticoagulant therapy was again associated with a reduction in the composite outcome (HR, 0.372; 95% CI, 0.236-0.587; P < .001) and also with death (HR, 0.281; 95% CI, 0.168-0.469; P < .001), even in patients with anticoagulant prescriptions initiated on discharge from the ED. These associations did not reach statistical significance in men.
Conclusions. ED anticoagulant prescription for elderly patients with atrial fibrillation is safe and contributes to a reduction in mortality. Women in this age group benefited more than men from starting anticoagulation during the acute phase in the ED.
Methods. Post-hoc analysis of data compiled by the EMERG-AF group (Spanish acronym for Emergency Department Stroke Prophylaxis and Guidelines Implementation in Atrial Fibrillation). Consecutive patients aged 75 years or older with atrial fibrillation who were treated in 62 EDs were included. We recorded clinical data and anticoagulants prescribed. Patients were followed for 1 year. The main outcome variable was a composite of death, thromboembolism, or major bleeding within 1 year.
Results. Data for 690 patients were registered; 386 (55.9%) were women. At discharge, 575 patients (83.3%) were on anticoagulants; therapy was started in the ED for 96 of them. A total of 158 patients (22.9%) had experienced at least 1 component of the main outcome within 1 year: 118 (17.1%) died, 22 (2.7%) had thromboembolic complications, and 34 (4.9%) had major bleeding. After adjustment for main clinical characteristics, hazard ratios (HRs) showed that anticoagulation therapy was associated with a reduction in the composite outcome (HR, 0.372; 95% CI, 0.236-0.587; P < .001) but not specifically with major bleeding overall. When data for women were analyzed separately, anticoagulant therapy was again associated with a reduction in the composite outcome (HR, 0.372; 95% CI, 0.236-0.587; P < .001) and also with death (HR, 0.281; 95% CI, 0.168-0.469; P < .001), even in patients with anticoagulant prescriptions initiated on discharge from the ED. These associations did not reach statistical significance in men.
Conclusions. ED anticoagulant prescription for elderly patients with atrial fibrillation is safe and contributes to a reduction in mortality. Women in this age group benefited more than men from starting anticoagulation during the acute phase in the ED.
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