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Abstract Details

Variations in Anticoagulation Prescribing Practices for Short Episodes of Atrial Fibrillation in Clinical Practice
Cerebrovascular Disease and Interventional Neurology
P07 - (-)
245
BACKGROUND: Short episodes of atrial fibrillation (<30 seconds) are found frequently in association with cryptogenic stroke and the decision to anticoagulate is a source of controversy in clinical practice.
DESIGN/METHODS: All CardioNet ® MCOT records for 18 months from June 2009 to January 2012, prescribed by a neurologist, at a large tertiary care hospital for patients with a cryptogenic stroke or TIA within 6 months of the index event were retrospectively reviewed. Data was collected on patient demographics, clinical history, duration of atrial fibrillation, prescribing practices and incidence of recurrent stroke or hemorrhage.
RESULTS: 39 patients were found to have atrial fibrillation and their records were reviewed. Atrial fibrillation episodes were categorized as <30 seconds in 24 (62%) of patients and ?30 seconds in 15 (38%). Average follow-up was 25 months. Among the 16 patients without a cardiology evaluation, the rate of anti-coagulation was high and did not differ for patients with short Afib (90%, 9 to 10) and long Afib (83%, 5 of 6) (p>0.99, Fisher's exact test). However, among the 23 patients with a cardiology evaluation, the difference in rates of anti-coagulation was significant between patients with short afib (43%, 6 of 14) and long afib (89%, 8 of 9) (p=0.039, Fisher's exact test). Thus it appears that cardiology evaluation status may influence the anti-coagulation rates for patients with short vs long Afib. Two of 9 (22.2%) patients with short atrial fibrillation not anticoagulated had a recurrent ischemic infarct, 1 of 9 had a groin hematoma.
CONCLUSIONS: Variability and indecision exists when determining the need for anticoagulation in cryptogenic stroke patients with short, ?30 second, episodes of atrial fibrillation. Further study to determine the risk of recurrent ischemic stroke and benefit of anticoagulation is needed.
Authors/Disclosures
Muhib Khan, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic)
PRESENTER 		The institution of Dr. Khan has received research support from Mayo Clinic Â鶹´«Ã½Ó³»­ Grant . The institution of Dr. Khan has received research support from Mayo Clinic Small Grants .
Daniel Miller, MD Dr. Miller has nothing to disclose.
Lonni Schultz, PhD (Henry Ford Hospital) Dr. Schultz has nothing to disclose.
Bruce S. Rubin, MD, FÂ鶹´«Ã½Ó³»­ (Design Neuroscience Center) No disclosure on file