• Mercedes Varona, Alfonso Martín, Juan Sánchez, Juan Tamargo, Manuel Cancio, Susana Sánchez, José Carbajosa, Amparo Fernández de Simón, José Ríos, Carmen Del Arco, José Ormaetxe, Coral Suero, Blanca Coll-Vinent, and Investigadores del estudio EMERG-AF.
• Grupo de Arritmias Cardiacas y Síncope de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), España. Servicio de Urgencias, Hospital Universitario de Basurto, Universidad del País Vasco, Bilbao, España.
• Emergencias. 2023 Aug 1; 35 (4): 252260252-260.

ObjectivesTo 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.Material And MethodsPost-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.ResultsData 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.ConclusionED 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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