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Starting anticoagulation for atrial fibrillation in the emergency department safely
  1. Christopher Kirwan1,
  2. Sophie Ramsden2,
  3. Jaimee Carter2,
  4. X Catherine Tong3,
  5. Johnny Huang4,
  6. Natasha Clayton5,
  7. Robyn McArthur6,
  8. Aqsa Kibria7,
  9. Kerstin de Wit8
  1. 1Department of Family Medicine, Queen’s University Faculty of Health Sciences, Kingston, Ontario, Canada
  2. 2Department of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
  3. 3Department of Family Medicine, McMaster University, Kitchener, Ontario, Canada
  4. 4Department of Family Medicine, McMaster University, Cambridge, Ontario, Canada
  5. 5Department of Emergency Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
  6. 6Department of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
  7. 7Medical School, Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
  8. 8Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
  1. Correspondence to Professor Kerstin de Wit, Emergency Medicine, Queen's University, Kingston, Canada; kerstin.dewit{at}

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Atrial fibrillation (AF) is a common morbidity, which is increasing in prevalence.1 AF predisposes patients to stroke while anticoagulation therapy reduces the stroke risk in this population. The proportion of patients with AF receiving oral anticoagulation is one of the pan-Canadian quality indicators set by the Canadian Cardiovascular Society.2 Our review of local ED practice identified that only 17% of patients with AF eligible for anticoagulation were being prescribed an anticoagulant.3 We implemented a simple ED pathway for initiating anticoagulation in patients with AF in four EDs. The pathway was available for emergency patients who had a diagnosis of AF or atrial flutter (new-onset or previously known) being discharged home. We determined the proportion of patients who were appropriately anticoagulated and 90-day clinical outcomes.

Rapid specialist follow-up, reliable communication with the family doctor and ease of patient education increase ED doctor comfort in prescribing anticoagulation for AF.4 Using these principles, a multidisciplinary, multisite working group developed a one-page pathway to guide assessment …

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  • Handling editor Edward Carlton

  • Twitter @XC_TongMD

  • Contributors The study was designed by KdW. The study was conducted by CW, SR, JC, XCT, JH, NC, RMcA and AK. Analysis was performed by KdW and all authors helped draft the manuscript.

  • Funding This hospital programme is partly funded by a grant from Bayer (Bayer manufacture rivaroxaban, which is an anticoagulant used in the prevention of stroke for patients with atrial fibrillation).

  • Provenance and peer review Not commissioned; externally peer reviewed.